Urgent Action Needed by All Ophthalmologists to Stop Dangerous Optometric Surgery Bill

[4ophtho]

From the Academy:

A dangerous bill that authorizes Louisiana optometrists to perform scalpel and laser surgery awaits action by Gov. Bobby Jindal. The Louisiana House and Senate passed HB 1065 earlier this month. Lawmakers approved the bill despite aggressive advocacy efforts by the Louisiana Ophthalmology Association, the Louisiana State Medical Society and the Academy. The physician coalition has been educating the lawmakers about the dangers posed by optometric surgery since January.

HB 1065 authorizes optometrists to:

• Perform scalpel eyelid surgeries on lesions, cysts and chalazia;
• Perform glaucoma laser surgery (SLT and ALT) and YAG capsulotomy.

In addition, the bill removes the authority of the Louisiana State Board of Medical Examiners to set ophthalmic-surgery standards that protect patients.

Louisiana bill has nationwide implications on patient safety
HB 1065 has implications on ophthalmologists across the United States. If enacted, it provides optometrists with another foothold in their nation-wide grasp for surgery privileges. Optometrists in Kentucky and Oklahoma already have scalpel and laser surgery authority. There also is legislation pending in California, Delaware and Massachusetts.

Take action now!
Gov. Jindal has 10 days to veto this dangerous bill or sign it into law. If he does not act within that time, HB 1065 automatically becomes law.

Every Academy member is encouraged to contact Gov. Jindal today. Call him at 225.342.7015 or 866.366.1121. Ask the governor to veto HB 1065. Tell him:

• HB 1065 removes patient safety and surgical standards provided by the Board of Medical Examiners.
• A 32-hour surgery “training” course proposed by the Board of Optometry does not make a trained surgeon.

For more information, contact the Academy’s Government Affairs division at 202.737.6662.

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Members don't see this ad.

 

[OphthoPractice]

If it already passed the House and Senate, it's probably going to go through. I'd imagine it'd be harder to convince dozens of ppl in Senate and House than the one governor. Pretty sad.

Even though these rights already exist in a few states, are optometrists actually doing them in these states? I heard that in Oklahoma most optometrists know their level of training and thus still do not perform these procedures due to the liability. Anyone have any more info on this?

 

[east]

This isn't gonna stop. The only chance Ophthalmology has is for Optometric Scope to expand enough so that iatrogenic blindness occurs significant enough to get the public's attention. If that doesn't manifest..... then the scope expansion train rolls on. And no, most optometrists will not be preforming many of these procedures. Some with large practices and networks would stand to make a decent return, and will participate.

 

[DermViser]

This isn't gonna stop. The only chance Ophthalmology has is for Optometric Scope to expand enough so that iatrogenic blindness occurs significant enough to get the public's attention. If that doesn't manifest..... then the scope expansion train rolls on. And no, most optometrists will not be preforming many of these procedures. Some with large practices and networks would stand to make a decent return, and will participate.

Good grief, I thought optometrists only did evaluation for corrective lenses only. Scary that they'd actually do surgery.

 

[ophthope]

This isn't gonna stop. The only chance Ophthalmology has is for Optometric Scope to expand enough so that iatrogenic blindness occurs significant enough to get the public's attention. If that doesn't manifest..... then the scope expansion train rolls on. And no, most optometrists will not be preforming many of these procedures. Some with large practices and networks would stand to make a decent return, and will participate.

It will probably even have to specifically be some Senator or Representative, Mayor, Governor, etc or their family that has a bad outcome for anything to happen.

 

[syma]

Good grief, I thought optometrists only did evaluation for corrective lenses only. Scary that they'd actually do surgery.

They do a bit more than evaluation for corrective lenses. But I do agree it is scary that they are essentially given the right to do surgery. But I doubt many are running to learn how or even concerned about it. I would hazard a guess this is better suited for ophthalmology led clinics that don't have the man power to see the patients that require the aforementioned treatments.

After all, that's how optometry as a field first emerged.

 

[DermViser]

They do a bit more than evaluation for corrective lenses. But I do agree it is scary that they are essentially given the right to do surgery. But I doubt many are running to learn how or even concerned about it. I would hazard a guess this is better suited for ophthalmology led clinics that don't have the man power to see the patients that require the aforementioned treatments.

After all, that's how optometry as a field first emerged.

I think part of the thing is that when scope of practice laws change, then optometry schools will change to accomodate this change so their graduates are "functional" on practice. It's important to prevent a domino effect.

To think 10 years ago, this would have been unheard of. Of course when you have an optometrist politician believing that optometrists can manage diabetes, then anything is possible: http://medcitynews.com/2013/02/cali...sts-eye-docs-diagnose-and-treat-diabetes-hbp/

 

[ophthope]

They do a bit more than evaluation for corrective lenses. But I do agree it is scary that they are essentially given the right to do surgery. But I doubt many are running to learn how or even concerned about it. I would hazard a guess this is better suited for ophthalmology led clinics that don't have the man power to see the patients that require the aforementioned treatments.

After all, that's how optometry as a field first emerged.

Syma if your title is true (Optometrist and Medical Student) then once you finish your training you'll be in a unique position to comment on the differences between Physician education and Optometrist education. I've only ever met one Optometrist-turned-Ophthalmologist.

Thinking about sticking with the eyes or is another field looking more interesting to you at this point?

 

[syma]

I think part of the thing is that when scope of practice laws change, then optometry schools will change to accomodate this change so their graduates are "functional" on practice. It's important to prevent a domino effect.

To think 10 years ago, this would have been unheard of. Of course when you have an optometrist politician believing that optometrists can manage diabetes, then anything is possible: http://medcitynews.com/2013/02/cali...sts-eye-docs-diagnose-and-treat-diabetes-hbp/

Oh absolutely. I also think it is important that optometrists know their limitations and why they can't or shouldn't treat diabetes or any other systemic disease that happens to affect the eyes.

I wonder if it would be a postgraduate type training rather than squeezed into a already packed 4 years.

Syma if your title is true (Optometrist and Medical Student) then once you finish your training you'll be in a unique position to comment on the differences between Physician education and Optometrist education. I've only ever met one Optometrist-turned-Ophthalmologist.

Thinking about sticking with the eyes or is another field looking more interesting to you at this point?

I would never dispute the difference between training of an optom and a physician. I cannot argue against NP encroachment and be ok with optoms doing the same. However, from my experience I am not sure if ophthalmologists appreciate and understand what an optom can do. They can work very well together without an optom having to know how to do anything beyond their current scope.

I am currently doing a hospital audit on an optometrist led glaucoma clinic (no surgery!!) Would be happy to share my findings.

(Not 100% sold on ophthalmology, because of the surgical side of things, (irony) but being open minded)

 

[dantt]

It will probably even have to specifically be some Senator or Representative, Mayor, Governor, etc or their family that has a bad outcome for anything to happen.

Which is not going to happen because said Senator or Representative, Mayor, Governor, etc are not going to their optometrist for surgery.

 

[DrVinzKlortho]

Oh absolutely. I also think it is important that optometrists know their limitations and why they can't or shouldn't treat diabetes or any other systemic disease that happens to affect the eyes.

I wonder if it would be a postgraduate type training rather than squeezed into a already packed 4 years.



I would never dispute the difference between training of an optom and a physician. I cannot argue against NP encroachment and be ok with optoms doing the same. However, from my experience I am not sure if ophthalmologists appreciate and understand what an optom can do. They can work very well together without an optom having to know how to do anything beyond their current scope.

I am currently doing a hospital audit on an optometrist led glaucoma clinic (no surgery!!) Would be happy to share my findings.

(Not 100% sold on ophthalmology, because of the surgical side of things, (irony) but being open minded)

I'll play. A little bit of background about me. I'm an OD that graduated 3 years that practices in the north east. I trained at a school that does a multidisciplinary approach to the basic science portion of the curriculum. Anatomy, pharmacology, neuro, physio, etc were all courses taken by ODs as well as other medical professionals that have a much broader scope of practice than ODs. During my training I was trained above and beyond the scope of practice that any state is currently at. I had to get certified for all sorts of injection techniques (which is now required for NBEO part 3), I took an advanced procedures course (which included suturing, etc.) and an anterior segment lasers certification course. During my 4th year rotations I had first hand experience with performing different procedures including I+D, chalazion removal, injections, IPL for MGD/DES, countless foreign body removals, Nd: Yag capsulotomy (4), LPI (3), SLT (2), countless epi debridements (for RCE, Salzmann's nodular dystrophy, etc.). From my experience with my classmates and colleagues from other schools my training was on par with other recent grads.

One of the larger problems I see with my profession is a lack of understanding of what we are, what we do, what we can do, what we are trained to do, and what we want to do. There is certainly an identity issue within Optometry (I could talk for hours on this issue alone). Whether it's the public or other medical professionals--nobody truly knows what an OD is. One of the arguments being made here is that legislation is preceding training. I can't agree with this--it's simply not true based on my experience and the experience of other recently trained graduates (I obviously cannot comment on the training of those that came before me).

Syma I agree with others that you are in a unique position to offer differences in training however it should also be noted that you were trained overseas in the UK--am I correct?

So I'll ask: what should an OD do? Ophthalmology typically says that we should stick to refractive care: glasses, contacts, low vision, vision therapy, etc. Some ODs will argue that we should practice to the level of our training--and there are some ODs practicing to the full extent of their training. Other ODs are cantankerous, don't want to learn or progress, and are happy refracting and selling spectacles--there are certainly plenty in this category as well.

Is there a need for ODs performing these surgeries? Optometry, within its current scope in the US, is beyond over saturated. Big time. Ophthalmology, from my experience, is also over saturated. I work in a large city so I can't comment on extremely rural areas so it's difficult to gauge as to whether or not there is a need based on my experience.

What about primary medical care: are ODs capable of managing hypertension, diabetes, hypercholesterolemia, etc? From a diagnostic point of view every OD has seen diabetic or hypertensive retinopathy in a systemically undiagnosed patient. We deal with thyroid issues. We see undiagnosed hypercholesterolemia. We, often times, are the first to see auto-immune disorders. In the past 2 months alone I've personally diagnosed MS, Crohn's/UC, hyperthyroid, pseudotumor, Marfan's syndrome, pituitary adenoma, and countless other systemic issues. I refer to the appropriate specialist and treat the ocular sequelae. So the question arises--if there is a shortage of primary care providers should ODs fill in that gap? Certainly the training of ODs surpasses PAs and is leaps and bounds beyond NPs yet theses providers have been filling in the primary care gap for years. If the appropriate competency based educational program/internship existed why shouldn't ODs fill this gap?

So what should we all do about it? As it stands if someone like myself wanted to go back and do surgery or practice primary care medicine I'd have to start from scratch: 4 years of medical school, 3+ years of residency. My OD degree was friggin' expensive. It is cost prohibitive for myself or other ODs to do this in this day and age. Back 20-30 years ago if an OD wanted to be an Ophthalmologist or another medical practitioner it made sense for the OD to go back to medical school: the medical portion of the OD curriculum wasn't up to it's current level, the cost of tuition was nowhere near what it is today, the scope of OD practice was nowhere what it is today. ODs are very underutilized. With the appropriate program (OD to MD/DO bridge/residency or something comparable) there is no logical reason ODs shouldn't be able to treat.

Any opinions?

 

[OphthoPractice]

I'll play. A little bit of background about me. I'm an OD that graduated 3 years that practices in the north east. I trained at a school that does a multidisciplinary approach to the basic science portion of the curriculum. Anatomy, pharmacology, neuro, physio, etc were all courses taken by ODs as well as other medical professionals that have a much broader scope of practice than ODs. During my training I was trained above and beyond the scope of practice that any state is currently at. I had to get certified for all sorts of injection techniques (which is now required for NBEO part 3), I took an advanced procedures course (which included suturing, etc.) and an anterior segment lasers certification course. During my 4th year rotations I had first hand experience with performing different procedures including I+D, chalazion removal, injections, IPL for MGD/DES, countless foreign body removals, Nd: Yag capsulotomy (4), LPI (3), SLT (2), countless epi debridements (for RCE, Salzmann's nodular dystrophy, etc.). From my experience with my classmates and colleagues from other schools my training was on par with other recent grads.

One of the larger problems I see with my profession is a lack of understanding of what we are, what we do, what we can do, what we are trained to do, and what we want to do. There is certainly an identity issue within Optometry (I could talk for hours on this issue alone). Whether it's the public or other medical professionals--nobody truly knows what an OD is. One of the arguments being made here is that legislation is preceding training. I can't agree with this--it's simply not true based on my experience and the experience of other recently trained graduates (I obviously cannot comment on the training of those that came before me).

Syma I agree with others that you are in a unique position to offer differences in training however it should also be noted that you were trained overseas in the UK--am I correct?

So I'll ask: what should an OD do? Ophthalmology typically says that we should stick to refractive care: glasses, contacts, low vision, vision therapy, etc. Some ODs will argue that we should practice to the level of our training--and there are some ODs practicing to the full extent of their training. Other ODs are cantankerous, don't want to learn or progress, and are happy refracting and selling spectacles--there are certainly plenty in this category as well.

Is there a need for ODs performing these surgeries? Optometry, within its current scope in the US, is beyond over saturated. Big time. Ophthalmology, from my experience, is also over saturated. I work in a large city so I can't comment on extremely rural areas so it's difficult to gauge as to whether or not there is a need based on my experience.

What about primary medical care: are ODs capable of managing hypertension, diabetes, hypercholesterolemia, etc? From a diagnostic point of view every OD has seen diabetic or hypertensive retinopathy in a systemically undiagnosed patient. We deal with thyroid issues. We see undiagnosed hypercholesterolemia. We, often times, are the first to see auto-immune disorders. In the past 2 months alone I've personally diagnosed MS, Crohn's/UC, hyperthyroid, pseudotumor, Marfan's syndrome, pituitary adenoma, and countless other systemic issues. I refer to the appropriate specialist and treat the ocular sequelae. So the question arises--if there is a shortage of primary care providers should ODs fill in that gap? Certainly the training of ODs surpasses PAs and is leaps and bounds beyond NPs yet theses providers have been filling in the primary care gap for years. If the appropriate competency based educational program/internship existed why shouldn't ODs fill this gap?

So what should we all do about it? As it stands if someone like myself wanted to go back and do surgery or practice primary care medicine I'd have to start from scratch: 4 years of medical school, 3+ years of residency. My OD degree was friggin' expensive. It is cost prohibitive for myself or other ODs to do this in this day and age. Back 20-30 years ago if an OD wanted to be an Ophthalmologist or another medical practitioner it made sense for the OD to go back to medical school: the medical portion of the OD curriculum wasn't up to it's current level, the cost of tuition was nowhere near what it is today, the scope of OD practice was nowhere what it is today. ODs are very underutilized. With the appropriate program (OD to MD/DO bridge/residency or something comparable) there is no logical reason ODs shouldn't be able to treat.

Any opinions?

What you say is interesting but still nothing compared to ophtho residency. While required laser numbers are not high for residency, the amount of lasers done by most residents is probably 10-100x what you had in optometry school.

And I also question that you actually "diagnose" those things. I suspect you had a hunch on what the pts had but I question if you were actually the one to entire physical exam beyond the scope of the eyes and order the appropriate tests to actually diagnose them. If my suspicions are correct then you didn't diagnose anything.

My gut tells me your post is typically what you see ppl with lesser education argue. Your classes have the same names as med school's and you do a small fraction of what ophtho residents do and thus think you receive near equivalent education. I've heard community college pre nursing students make the same arguments. I don't know if that's the case here but that's what I suspect.

If optoms really wanna do more then they need optometry residencies, not these weekend long courses to certify them in lasers. Optom school may have been costly but that was your own choice. You knew what you were getting yourself into when you applied. And if you didn't that's also your fault. You shouldn't be allowed to expand your scope of practice politically rather than better education. Politicians don't know anything about medicine but then are passing all these bogus bills. It's sad.

 

[DrVinzKlortho]

What you say is interesting but still nothing compared to ophtho residency. While required laser numbers are not high for residency, the amount of lasers done by most residents is probably 10-100x what you had in optometry school.

And I also question that you actually "diagnose" those things. I suspect you had a hunch on what the pts had but I question if you were actually the one to entire physical exam beyond the scope of the eyes and order the appropriate tests to actually diagnose them. If my suspicions are correct then you didn't diagnose anything.

My gut tells me your post is typically what you see ppl with lesser education argue. Your classes have the same names as med school's and you do a small fraction of what ophtho residents do and thus think you receive near equivalent education. I've heard community college pre nursing students make the same arguments. I don't know if that's the case here but that's what I suspect.

If optoms really wanna do more then they need optometry residencies, not these weekend long courses to certify them in lasers. Optom school may have been costly but that was your own choice. You knew what you were getting yourself into when you applied. And if you didn't that's also your fault. You shouldn't be allowed to expand your scope of practice politically rather than better education. Politicians don't know anything about medicine but then are passing all these bogus bills. It's sad.

I didn't say that with my handful of patients that I'm ready to go blasting the world's eyes with lasers--you're inferring what you want to infer from my post. I asked "what should we do about it?" Optometry currently has one or two (rare) year residencies. Is that enough? What's enough? How many LPIs before someone is competent? Don't feed me the bs that we can't handle the complications because when we're referring/co-managing patients often times we're dealing with the post-op issues.

I'm going to say something that's going upset a lot of people out there.....it's not difficult to diagnose diabetes (OMG!). I'd argue glaucoma is more difficult to diagnose and treat--yet I do this daily. Yes, I can order blood work. Yes, I've made the diagnosis. Yes, in my state I can bill a 250.xx code. Believe it or not, in my weekend community college night school OD degree program we actually learned how to read. We didn't take courses with the same names. We took the same courses--side-by-side. Let me guess we were given easier test questions? We take evidence based medicine. We discuss landmark studies: OHTS, ALLHAT, ACCORD, AREDS, etc. etc. My gut tells me your post is typically what you see when someone doesn't understand the education or background of another professional.

 

[seanb9]

Getting back to HB 1065 in Louisiana. The main issue with this bill is the oversight. The way in which it is written it will allow oversight to be done by the Louisiana Optometry board (for the same procedures that ophthalmologist do and are currently overseen by the state medical board). Additionally, it will allow the optometry board to define what the practice of optometry is in the future without having to return to the legislature. Currently, in Louisiana MDs, DOs, podiatrist, NPs, Chiropractors, etc are all under jurisdiction of the Louisiana State Medical Board of examples. For example, podiatrist (unlike optometrist complete a surgical residency) operate on the toe and doing many of the same surgeries that an orthopod can do, however both are under the medical board. The bill also allows for optometrist to prescribe class 3 medications (i.e. steriods, codeine, and hydro-codone based opioid).

ps. There's a little bit of conflict of interest behind this whole thing. The chairman of the senate health and welfare committee is an OPTOMETRIST.

 

[JMK2005]

I'll play. A little bit of background about me. I'm an OD that graduated 3 years that practices in the north east. I trained at a school that does a multidisciplinary approach to the basic science portion of the curriculum. Anatomy, pharmacology, neuro, physio, etc were all courses taken by ODs as well as other medical professionals that have a much broader scope of practice than ODs. During my training I was trained above and beyond the scope of practice that any state is currently at. I had to get certified for all sorts of injection techniques (which is now required for NBEO part 3), I took an advanced procedures course (which included suturing, etc.) and an anterior segment lasers certification course. During my 4th year rotations I had first hand experience with performing different procedures including I+D, chalazion removal, injections, IPL for MGD/DES, countless foreign body removals, Nd: Yag capsulotomy (4), LPI (3), SLT (2), countless epi debridements (for RCE, Salzmann's nodular dystrophy, etc.). From my experience with my classmates and colleagues from other schools my training was on par with other recent grads.

One of the larger problems I see with my profession is a lack of understanding of what we are, what we do, what we can do, what we are trained to do, and what we want to do. There is certainly an identity issue within Optometry (I could talk for hours on this issue alone). Whether it's the public or other medical professionals--nobody truly knows what an OD is. One of the arguments being made here is that legislation is preceding training. I can't agree with this--it's simply not true based on my experience and the experience of other recently trained graduates (I obviously cannot comment on the training of those that came before me).

Syma I agree with others that you are in a unique position to offer differences in training however it should also be noted that you were trained overseas in the UK--am I correct?

So I'll ask: what should an OD do? Ophthalmology typically says that we should stick to refractive care: glasses, contacts, low vision, vision therapy, etc. Some ODs will argue that we should practice to the level of our training--and there are some ODs practicing to the full extent of their training. Other ODs are cantankerous, don't want to learn or progress, and are happy refracting and selling spectacles--there are certainly plenty in this category as well.

Is there a need for ODs performing these surgeries? Optometry, within its current scope in the US, is beyond over saturated. Big time. Ophthalmology, from my experience, is also over saturated. I work in a large city so I can't comment on extremely rural areas so it's difficult to gauge as to whether or not there is a need based on my experience.

What about primary medical care: are ODs capable of managing hypertension, diabetes, hypercholesterolemia, etc? From a diagnostic point of view every OD has seen diabetic or hypertensive retinopathy in a systemically undiagnosed patient. We deal with thyroid issues. We see undiagnosed hypercholesterolemia. We, often times, are the first to see auto-immune disorders. In the past 2 months alone I've personally diagnosed MS, Crohn's/UC, hyperthyroid, pseudotumor, Marfan's syndrome, pituitary adenoma, and countless other systemic issues. I refer to the appropriate specialist and treat the ocular sequelae. So the question arises--if there is a shortage of primary care providers should ODs fill in that gap? Certainly the training of ODs surpasses PAs and is leaps and bounds beyond NPs yet theses providers have been filling in the primary care gap for years. If the appropriate competency based educational program/internship existed why shouldn't ODs fill this gap?

So what should we all do about it? As it stands if someone like myself wanted to go back and do surgery or practice primary care medicine I'd have to start from scratch: 4 years of medical school, 3+ years of residency. My OD degree was friggin' expensive. It is cost prohibitive for myself or other ODs to do this in this day and age. Back 20-30 years ago if an OD wanted to be an Ophthalmologist or another medical practitioner it made sense for the OD to go back to medical school: the medical portion of the OD curriculum wasn't up to it's current level, the cost of tuition was nowhere near what it is today, the scope of OD practice was nowhere what it is today. ODs are very underutilized. With the appropriate program (OD to MD/DO bridge/residency or something comparable) there is no logical reason ODs shouldn't be able to treat.

Any opinions?

I am calling BS on this post.

 

[syma]

I am calling BS on this post.

On which part?

Getting back to HB 1065 in Louisiana. The main issue with this bill is the oversight. The way in which it is written it will allow oversight to be done by the Louisiana Optometry board (for the same procedures that ophthalmologist do and are currently overseen by the state medical board). Additionally, it will allow the optometry board to define what the practice of optometry is in the future without having to return to the legislature. Currently, in Louisiana MDs, DOs, podiatrist, NPs, Chiropractors, etc are all under jurisdiction of the Louisiana State Medical Board of examples. For example, podiatrist (unlike optometrist complete a surgical residency) operate on the toe and doing many of the same surgeries that an orthopod can do, however both are under the medical board. The bill also allows for optometrist to prescribe class 3 medications (i.e. steriods, codeine, and hydro-codone based opioid).

ps. There's a little bit of conflict of interest behind this whole thing. The chairman of the senate health and welfare committee is an OPTOMETRIST.

So if optometrists were governed the same way NPs, chiropractors etc are currently in your state, how would your opinion change if at all?

 

[DrVinzKlortho]

I am calling BS on this post.

100% true. What do I have to gain by embellishing? If you want specifics feel free to PM me.

 

[JWSIV]

Deleted

 

[MeetJoeBlack]

I didn't say that with my handful of patients that I'm ready to go blasting the world's eyes with lasers--you're inferring what you want to infer from my post. I asked "what should we do about it?" Optometry currently has one or two (rare) year residencies. Is that enough? What's enough? How many LPIs before someone is competent? Don't feed me the bs that we can't handle the complications because when we're referring/co-managing patients often times we're dealing with the post-op issues.

I'm going to say something that's going upset a lot of people out there.....it's not difficult to diagnose diabetes (OMG!). I'd argue glaucoma is more difficult to diagnose and treat--yet I do this daily. Yes, I can order blood work. Yes, I've made the diagnosis. Yes, in my state I can bill a 250.xx code. Believe it or not, in my weekend community college night school OD degree program we actually learned how to read. We didn't take courses with the same names. We took the same courses--side-by-side. Let me guess we were given easier test questions? We take evidence based medicine. We discuss landmark studies: OHTS, ALLHAT, ACCORD, AREDS, etc. etc. My gut tells me your post is typically what you see when someone doesn't understand the education or background of another professional.

"My gut tells me your post is typically what you see when someone doesn't understand the education or background of another profession."

My thoughts exactly. You have proven your own point with your above statements. Your comments demonstrate that one cannot possibly understand the education or background of the medical profession by simply sitting beside a medical student in basic science courses for two years. If you require an explanation for this statement then the answer is that you need more training. Go to medical school. Perhaps the answer lies in the ladder two years and beyond that you unfortunately missed.

"100% true. What do I have to gain by embellishing? If you want specifics feel free to PM me."

The point of this bill is to legally and ultimately expand your scope of practice. You, as an optometrist, have everything to gain. The most you stand to lose is a denied bill, but that won't stop the next optometry-backed lobbying initiative to expand scope of practice. You try and equate your training to ophthalmology by telling us what you have done in optometry school. The "overtrained" argument -- outstanding. I did a lot in medical school and residency, including surgery on live animals, but I still take my cat to a vet; I still take my daughter to a pediatrician; and I would be happy to take you to a psychiatrist any day of the week. You try and justify an expansion of your profession by saying that optometry is "oversaturated" then point to ophthalmology as another oversaturated profession. But are ophthalmologists lobbying to move into other surgical realms? No. By hook or by crook, gain is exactly what you seek by "embelleshing" in your exceptional training during optometry school. Don't deny to us that you feel you are prepared to "go blasting the world's eyes with lasers". Your comments are ripe with arrogance and feelings of professional overtraining, oversaturation, adequecy, underrecognition, and underutilization. You have undoubtedly established your position that optometrists are appropriately expanding scope of practice into medicine and surgery. Do you think we don't read the optometry board? Most recent comment in SDN optometry by DrVinzKlortho regarding collagen cross-linking: "This thread is all over the place but I want to comment on the K CXL'ing: nothing that is done during the procedure is outside of ODs current scope of practice." Ridiculous. According to the FDA, collegen cross-linking isn't even within the U.S. ophthalmologists current scope of practice. I get your point, but, again, it's ridiculous; I can technically do many aspects if not entire procedures performed by other specialties, but I would never attempt them, much less seek legislation to allow me to do such things outside of my profession. Statements like yours only incite conflict within the field of eye care.

"I'm going to say something that's going upset a lot of people out there.....it's not difficult to diagnose diabetes (OMG!). "

I'm going to say something that's going to upset almost nobody out there....it's not difficult to diagnose diabetes. Again, you need medical training before speaking on behalf of the medical profession. We know it isn't difficult to diagnose diabetes "(OMG!)".

"So I'll ask: what should an OD do?"

You followed your own question with the correct answer. Listen to your "cantakerous" colleagues. I respect your training which is well-grounded and firmly established in delivering "refractive care: glasses, contacts, low vision, vision therapy, etc." And, there is a clear route for those who wish to do more: go to medical school and complete a residency in ophthalmology. Whether its glory or gold you desire, if you wish to practice the higher levels of eye care that optometrists seek to capture through bills like the abovementioned then take on the same risks and rewards we all do in order to join the wonderful profession of ophthalmology. I can only surmise that it would be no problem for you to dominate medical school because you previously sat in the exact same classes and answered the exact same questions as medical students. In fact, the very art of "reading" you learned in community college should enable you to sit for your USMLE Step 1, 2, and 3 exams right now. Without question, you have been well-prepared through both community college and optometry school to practice medicine and surgery. Afterall, not only can you read, but you know how to diagnose diabetes, which makes medical doctors very mad.

SDN ophthalmologists and ophthalmology-bound students and physicians: Do we not have a new schnurek on our hands or is this the same guy with a new name?

 

[syma]

"So I'll ask: what should an OD do?" You followed your own question with the correct answer. Listen to your "cantakerous" colleagues. I respect your training which is well-grounded and firmly established in delivering "refractive care: glasses, contacts, low vision, vision therapy, etc."

But an optometrist scope is beyond refractive care. It is not unheard for an optometrist to identify that there is a medical problem beyond whether the patient can see 20/20 or not. And very likely that they can "identify" the specifics. No they cannot "diagnose" systemic diseases but it is within their remit to identify that it is not right.

I don't understand why the relationship between ophthalmologists and optometrists is so strained. The working relationship can be symbiotic. But I have read posts on here from ophthalmologists that claim there isn't even a need for optomestrists.

No I don't believe the scope needs to be expanded beyond its current model, but we need to appreciate the roles of each other, because there is some healthy overlap.

 

[TheLesPaul]

I'll play. A little bit of background about me. I'm an OD that graduated 3 years that practices in the north east. I trained at a school that does a multidisciplinary approach to the basic science portion of the curriculum. Anatomy, pharmacology, neuro, physio, etc were all courses taken by ODs as well as other medical professionals that have a much broader scope of practice than ODs.

Which school is this? I haven't heard of a medical school that has optometry students and medical students share a whole 2-year basic science curriculum. Furthermore, medical school is not just 2 years. There are also 2 years of rigorous clinical rotations where one consolidates all the information learned. Take our USMLEs and pass, and I'll believe your basic science education is equally as rigorous. The NPs tried, and couldn't.

What about primary medical care: are ODs capable of managing hypertension, diabetes, hypercholesterolemia, etc? From a diagnostic point of view every OD has seen diabetic or hypertensive retinopathy in a systemically undiagnosed patient. We deal with thyroid issues. We see undiagnosed hypercholesterolemia. We, often times, are the first to see auto-immune disorders. In the past 2 months alone I've personally diagnosed MS, Crohn's/UC, hyperthyroid, pseudotumor, Marfan's syndrome, pituitary adenoma, and countless other systemic issues. I refer to the appropriate specialist and treat the ocular sequelae. So the question arises--if there is a shortage of primary care providers should ODs fill in that gap? Certainly the training of ODs surpasses PAs and is leaps and bounds beyond NPs yet theses providers have been filling in the primary care gap for years. If the appropriate competency based educational program/internship existed why shouldn't ODs fill this gap?

There is a difference between recognizing a disease (be it DM2, HTN, or a pituitary tumor), and treating it. I certainly diagnose many brain tumors, thyroid abnormalities, and autoimmune conditions. Then, I work in conjunction with the appropriate specialist (Nsg, Endocrine, Rheum) to provide optimal care. My scope of practice does include the responsibility to diagnose these conditions; it does not include brain surgery or prescribing methimazole. Likewise, yours includes recognizing PCO, cataract, glaucoma, etc. It does not include the surgical treatment thereof. Also, the fact that you think an OD's training surpasses a PA's training for primary care is ludicrous.

P.S. DM2 is extremely easy to diagnose. All you need is an A1c.

 

[DrVinzKlortho]

"My gut tells me your post is typically what you see when someone doesn't understand the education or background of another profession."

My thoughts exactly. You have proven your own point with your above statements. Your comments demonstrate that one cannot possibly understand the education or background of the medical profession by simply sitting beside a medical student in basic science courses for two years. If you require an explanation for this statement then the answer is that you need more training. Go to medical school. Perhaps the answer lies in the ladder two years and beyond that you unfortunately missed.

"100% true. What do I have to gain by embellishing? If you want specifics feel free to PM me."

The point of this bill is to legally and ultimately expand your scope of practice. You, as an optometrist, have everything to gain. The most you stand to lose is a denied bill, but that won't stop the next optometry-backed lobbying initiative to expand scope of practice. You try and equate your training to ophthalmology by telling us what you have done in optometry school. The "overtrained" argument -- outstanding. I did a lot in medical school and residency, including surgery on live animals, but I still take my cat to a vet; I still take my daughter to a pediatrician; and I would be happy to take you to a psychiatrist any day of the week. You try and justify an expansion of your profession by saying that optometry is "oversaturated" then point to ophthalmology as another oversaturated profession. But are ophthalmologists lobbying to move into other surgical realms? No. By hook or by crook, gain is exactly what you seek by "embelleshing" in your exceptional training during optometry school. Don't deny to us that you feel you are prepared to "go blasting the world's eyes with lasers". Your comments are ripe with arrogance and feelings of professional overtraining, oversaturation, adequecy, underrecognition, and underutilization. You have undoubtedly established your position that optometrists are appropriately expanding scope of practice into medicine and surgery. Do you think we don't read the optometry board? Most recent comment in SDN optometry by DrVinzKlortho regarding collagen cross-linking: "This thread is all over the place but I want to comment on the K CXL'ing: nothing that is done during the procedure is outside of ODs current scope of practice." Ridiculous. According to the FDA, collegen cross-linking isn't even within the U.S. ophthalmologists current scope of practice. I get your point, but, again, it's ridiculous; I can technically do many aspects if not entire procedures performed by other specialties, but I would never attempt them, much less seek legislation to allow me to do such things outside of my profession. Statements like yours only incite conflict within the field of eye care.

"I'm going to say something that's going upset a lot of people out there.....it's not difficult to diagnose diabetes (OMG!). "

I'm going to say something that's going to upset almost nobody out there....it's not difficult to diagnose diabetes. Again, you need medical training before speaking on behalf of the medical profession. We know it isn't difficult to diagnose diabetes "(OMG!)".

"So I'll ask: what should an OD do?"

You followed your own question with the correct answer. Listen to your "cantakerous" colleagues. I respect your training which is well-grounded and firmly established in delivering "refractive care: glasses, contacts, low vision, vision therapy, etc." And, there is a clear route for those who wish to do more: go to medical school and complete a residency in ophthalmology. Whether its glory or gold you desire, if you wish to practice the higher levels of eye care that optometrists seek to capture through bills like the abovementioned then take on the same risks and rewards we all do in order to join the wonderful profession of ophthalmology. I can only surmise that it would be no problem for you to dominate medical school because you previously sat in the exact same classes and answered the exact same questions as medical students. In fact, the very art of "reading" you learned in community college should enable you to sit for your USMLE Step 1, 2, and 3 exams right now. Without question, you have been well-prepared through both community college and optometry school to practice medicine and surgery. Afterall, not only can you read, but you know how to diagnose diabetes, which makes medical doctors very mad.

SDN ophthalmologists and ophthalmology-bound students and physicians: Do we not have a new schnurek on our hands or is this the same guy with a new name?

Good chat

"My gut tells me your post is typically what you see when someone doesn't understand the education or background of another profession."

My thoughts exactly. You have proven your own point with your above statements. Your comments demonstrate that one cannot possibly understand the education or background of the medical profession by simply sitting beside a medical student in basic science courses for two years. If you require an explanation for this statement then the answer is that you need more training. Go to medical school. Perhaps the answer lies in the ladder two years and beyond that you unfortunately missed.

"100% true. What do I have to gain by embellishing? If you want specifics feel free to PM me."

The point of this bill is to legally and ultimately expand your scope of practice. You, as an optometrist, have everything to gain. The most you stand to lose is a denied bill, but that won't stop the next optometry-backed lobbying initiative to expand scope of practice. You try and equate your training to ophthalmology by telling us what you have done in optometry school. The "overtrained" argument -- outstanding. I did a lot in medical school and residency, including surgery on live animals, but I still take my cat to a vet; I still take my daughter to a pediatrician; and I would be happy to take you to a psychiatrist any day of the week. You try and justify an expansion of your profession by saying that optometry is "oversaturated" then point to ophthalmology as another oversaturated profession. But are ophthalmologists lobbying to move into other surgical realms? No. By hook or by crook, gain is exactly what you seek by "embelleshing" in your exceptional training during optometry school. Don't deny to us that you feel you are prepared to "go blasting the world's eyes with lasers". Your comments are ripe with arrogance and feelings of professional overtraining, oversaturation, adequecy, underrecognition, and underutilization. You have undoubtedly established your position that optometrists are appropriately expanding scope of practice into medicine and surgery. Do you think we don't read the optometry board? Most recent comment in SDN optometry by DrVinzKlortho regarding collagen cross-linking: "This thread is all over the place but I want to comment on the K CXL'ing: nothing that is done during the procedure is outside of ODs current scope of practice." Ridiculous. According to the FDA, collegen cross-linking isn't even within the U.S. ophthalmologists current scope of practice. I get your point, but, again, it's ridiculous; I can technically do many aspects if not entire procedures performed by other specialties, but I would never attempt them, much less seek legislation to allow me to do such things outside of my profession. Statements like yours only incite conflict within the field of eye care.

"I'm going to say something that's going upset a lot of people out there.....it's not difficult to diagnose diabetes (OMG!). "

I'm going to say something that's going to upset almost nobody out there....it's not difficult to diagnose diabetes. Again, you need medical training before speaking on behalf of the medical profession. We know it isn't difficult to diagnose diabetes "(OMG!)".

"So I'll ask: what should an OD do?"

You followed your own question with the correct answer. Listen to your "cantakerous" colleagues. I respect your training which is well-grounded and firmly established in delivering "refractive care: glasses, contacts, low vision, vision therapy, etc." And, there is a clear route for those who wish to do more: go to medical school and complete a residency in ophthalmology. Whether its glory or gold you desire, if you wish to practice the higher levels of eye care that optometrists seek to capture through bills like the abovementioned then take on the same risks and rewards we all do in order to join the wonderful profession of ophthalmology. I can only surmise that it would be no problem for you to dominate medical school because you previously sat in the exact same classes and answered the exact same questions as medical students. In fact, the very art of "reading" you learned in community college should enable you to sit for your USMLE Step 1, 2, and 3 exams right now. Without question, you have been well-prepared through both community college and optometry school to practice medicine and surgery. Afterall, not only can you read, but you know how to diagnose diabetes, which makes medical doctors very mad.

SDN ophthalmologists and ophthalmology-bound students and physicians: Do we not have a new schnurek on our hands or is this the same guy with a new name?

Welp--this has been a fun chat. I am in no way, shape or form comparable to Shrek or whatever his/her name was. I actually graduated from OD school.

2 years--you quickly forgot that OD school is in fact 4 years. Contrary to what you may want to believe we're not taking refracting 101 10 times a semester for our last 2 years. Some OD schools do have ODs performing lasers on animals. A simple google search will let you know which ones. When my dog is sick she goes to a vet. When a patient has a particular issue she goes to a particular specialist. I'm not holding on to anything outside my scope. Put your sexy guns away I didn't come on here saying that I want to be the next attending surgeon at Wilmer. By your same logic and rationale though diabetes should in fact be difficult to diagnose because apparently this is a skill set that could only be learned in an AAMC accredited medical school. A psychiatrist--LULZ. Dude I'm of sound mine--if you want to be mad at anyone be mad at the OD schools that are teaching this stuff. Trust me when I was sitting in primary skills doing Weber's test, deep tendon reflexes, PPDs etc. etc. I sometimes wondered why. Every US OD school is teaching this stuff. You're a smart fella--look up the curriculums yourself--I don't have to qualify myself to you. Don't polarize my points or put words in my mouth. And I didn't go to community college. I went to OD school--which has a lot of didactic and clinical medical coursework.

So let me ask you: should we not be Rx'ing orals? By your logic we should be nothing more than refracting opticians. I will admit I'm not a fan of prescribing diamox but should I not be allowed to do so? What about antivirals/antibiotics/steroids? This is stuff we have been prescribing for years and years--safely. Do you get mad every time a non-physician provider Rx's metformin? Because if that's the case MLPs throughout the country are "making medical doctors very mad."

NPs had a chance to sit for a watered-down version of step 3 with horrendous results. To my knowledge no such program exists for ODs but I agree with you that taking the USMLE is the only true way to put this matter to bed.

 

[4ophtho]

By your same logic and rationale though diabetes should in fact be difficult to diagnose because apparently this is a skill set that could only be learned in an AAMC accredited medical school.

Its so fruitless arguing with optoms. They just don't understand the complexity of what MDs are talking about. Of course it's easy to diagnose diabetes, but this optom doesn't understand the complexity of managing the disease, so he thinks that because he took a few physiology classes in school and has seen BDR that his skills are on par with MDs, NPs, or PAs
No MD with the understanding of disease and treatment would make the claims and deductions with such flawed reasoning out of ignorance and naïveté like this and other optoms .
It takes a little training to shoot a laser, but it takes a lot of experience and training to know when to use it. I fear for the patients who don't know any better that will get sub-par care at the hands of an over-ambitious optometrist.

 

[DrVinzKlortho]

You can stop using the "you don't know what you don't know" argument. It's old. And please don't compare my education to that of an NP or a PA. I received doctorate level training and education.

As far as when to shoot a laser: I've yet to have one patient I refer for an LPI not receive one. Or yag cap for that matter. So either the ophthalmologists I'm referring to don't know what they're doing either or I actually know wtf I'm doing. I'm going with the later. I'm sorry I got a good education, man.


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[LightBox]

Attention college students:

If you want to be an eye surgeon, follow the Ophthalmologist-route (i.e. med school, residency, +/- fellowship). Yes, that is the established route. We don't need anymore eye surgeons in the United States, especially ones coming from some "alternative" route. Thanks.

 

[MeetJoeBlack]

Good chat


Welp--this has been a fun chat. I am in no way, shape or form comparable to Shrek or whatever his/her name was. I actually graduated from OD school.

2 years--you quickly forgot that OD school is in fact 4 years. Contrary to what you may want to believe we're not taking refracting 101 10 times a semester for our last 2 years. Some OD schools do have ODs performing lasers on animals. A simple google search will let you know which ones. When my dog is sick she goes to a vet. When a patient has a particular issue she goes to a particular specialist. I'm not holding on to anything outside my scope. Put your sexy guns away I didn't come on here saying that I want to be the next attending surgeon at Wilmer. By your same logic and rationale though diabetes should in fact be difficult to diagnose because apparently this is a skill set that could only be learned in an AAMC accredited medical school. A psychiatrist--LULZ. Dude I'm of sound mine--if you want to be mad at anyone be mad at the OD schools that are teaching this stuff. Trust me when I was sitting in primary skills doing Weber's test, deep tendon reflexes, PPDs etc. etc. I sometimes wondered why. Every US OD school is teaching this stuff. You're a smart fella--look up the curriculums yourself--I don't have to qualify myself to you. Don't polarize my points or put words in my mouth. And I didn't go to community college. I went to OD school--which has a lot of didactic and clinical medical coursework.

So let me ask you: should we not be Rx'ing orals? By your logic we should be nothing more than refracting opticians. I will admit I'm not a fan of prescribing diamox but should I not be allowed to do so? What about antivirals/antibiotics/steroids? This is stuff we have been prescribing for years and years--safely. Do you get mad every time a non-physician provider Rx's metformin? Because if that's the case MLPs throughout the country are "making medical doctors very mad."

NPs had a chance to sit for a watered-down version of step 3 with horrendous results. To my knowledge no such program exists for ODs but I agree with you that taking the USMLE is the only true way to put this matter to bed.

Graduating from OD school is impressive, but it does not preclude you from advancing the same ideas as schnurek. I started typing a response, but then quickly remembered that EtherBunny said it as well as anyone on this very forum in a similar context a little over a year ago. Not surprisingly, EtherBunny was addressing a rising schnurek. Post #59. Thanks again, EtherBunny:

http://forums.studentdoctor.net/thr...po-steroids-and-narcotics-in-ga.988763/page-2

I would only add that, in response to your comment, we all know OD school is four years, and we can quibble over specifics but you spent at most 2 years alongside medical students. Ask any physician if they knew how to practice medicine and surgery after 2 years of medical school and the answer will be a resounding "no". In fact, it would still be a "no" if asked whether a physician knew how to practice medicine and surgery after 4 years of medical school. I'm sure nearly all physicians would agree that the bulk of practical knowledge in medicine comes during residency and fellowship. You may not take "refraction 101" ten times during OD school, but there is no way you are going to convince any rational mind in medicine that you completed anything equivalent to a full complement of medical school rotations in years 3 and 4 of OD school. Further, completing the USMLE steps would not put this matter of equivalence between optometrists and medical doctors to bed. Bubbling in correct answer choices on a test doesn't mean you know how to intubate, place a central line, perform a pelvic exam, manage a cirrhotic acute GI bleed, or appropriately and completely workup patients, interpret test results, and treat single or multiple concurrent systemic diseases (sometimes with conflicting therapies), yet all of these skills fall under the purview of a medical doctor. How? Well, its not entirely because we attended the first two years of medical school. You may know your Weber's test and how to check DTR's, and you may even learn how to pass all four USMLE exams, but you will not have the many years of hands-on training to achieve a minimum level of proficiency required to act as a medical doctor or surgeon. Listen, deep down I believe your intentions here are good but they're just misguided. Review the curricula of years 3 and 4 of medical school as well as the ACGME requirements of residency training and accept the fact that what optometry school teaches is simply not equivalent to medical school and residency, neither in breadth or depth. Optometric training is not on par with that of a medical doctor. If I'm incorrect, then your optometry training should enable you to jump right into the ED or ICU tomorrow and manage patients. It's only a little blurry vision in a diabetic with HHS and Fournier's gangrene, right? You've had two years of "medical school" during your optometric studies, you passed your boards, you know how to diagnose diabetes, and you said you did a few I&D's -- are you equivalent to a medical doctor? -- then you should be able to manage this condition, optometric physician. And, I mean that in the most respectful way possible.

 

[OPPforlife]

You can stop using the "you don't know what you don't know" argument. It's old. And please don't compare my education to that of an NP or a PA. I received doctorate level training and education."



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You know who else I've heard say this? Chiropractors.

 

[DrVinzKlortho]

You know who else I've heard say this? Chiropractors.

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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[OPPforlife]

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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All hail the great optometrist. The true bastion of healthcare!


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[DrZeke]

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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And there it is...

 

[Silent Cool]

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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Why didn't you just go to medical school?

 

[MD focus]

I heard there is a new bill that will allow ophthalmic assistants to prescribe glasses and contact lenses to help lower prices...Just kidding
But it if true that learning just one skill out of context like diagnosing diabetic retinopathy or doing a laser treatment is not difficult anybody can learn to do that in a relatively short period of time but that doesn't mean they should do it. That is the reason there are specialists. As a physician I know how to deliver babies but I leave that to the experts.

 

[MeetJoeBlack]

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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Yes, there it is. Nice to have you back, Schnurek. Touche -- you have successfully lobbied your way into obtaining limited surgical privileges yet nobody respects you the more for it. That said, do YOU actually live in a place where you can and do perform said surgery? If so, what eye surgeries do you actually perform? Do patients really come to you for surgery? I'm serious. And, do they know you aren't a licensed medical doctor or residency/fellowship trained surgeon or do you pawn yourself off as one (e.g. "optometric physician") to further conflate our fields and confuse the public on matters of optometry and ophthalmology?

Regardless, you raise an excellent point in that lawmakers can be manipulated in ways to legally qualify the unqualified to perform surgery. While the current establishment in ophthalmology is relatively safe and secure, well-insulated from such changes, those of us beginning in ophthalmology better take notes from our optometric colleagues. While most of us are sitting back in a cordial manner, failing to find effective counter-measures, optometrists are making big strides out of optometry and into medicine and surgery. I don't know the answer, but ophthalmologists, especially the establishment which carries most of the clout, better band together and start playing ball.

 

[DrZeke]

Can they prescribe in all 50 states and do surgery in three states? Because I can.


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This is so ridiculous.

I've been reading this thread for days and your arrogance is exactly why this situation is terrifying.

You give an example of non physicians prescribing drugs like metformin. It's hardly benign and requires a lot of appropriate follow up depending on the case. But yet you give it as an example because you oversimplify everything.

That's really the problem. I know people who are 35 years in practice who still get nervous with every case they take to the OR and take it very seriously. That's what makes a surgeon. You have to be humble, you have to anticipate the complications and know what to do. Not just assume that every case is routine and simple.

I think most residents like myself will agree that long gone are the days of 1st and 2nd year med school where you heard people say stuff like "ortho is easy. All they do is fix fractures". *just giving a classic example from a time where I know I was naive*, I have deep respect for my ortho colleagues. The majority of us have respect for all of our colleagues and realize that nobody's speciality is "simple" whether it's primary care, or neurosurgery. As you go through your physician training you see this. The fact that you think that something like diagnosing and treating diabetes is simple is a testament to how immature you are. I do think you need to go back and go to medical school and complete a residency if you intend to do procedures with your attitude.

 

[DrVinzKlortho]

Wow. I'm actually really surprised by some of these comments--and for a lot reasons. Apparently if you make one true comment it ruffles a bunch of supposed professionals' feathers. That makes me arrogant. Out of context sure it does. But when comparing my education to a non-prescribing professional it's a slap in the face.

So as I sit here on this beautiful Sunday morning about to drink a cup of French-pressed coffee I can't help but picture you guys last night--sitting, venting. Guys it was a Saturday night--weren't there better things to do than argue with an Optometrist? Your arguments remind me of people in the olden days that rejected heliocentricism. When I originally posted over here I wasn't trying to start a flame war--I actually presented an idea or a thought. However no one wants to actually answer me. I shouldn't say that I consistently get the "go to medical school do the full residency etc etc." that's an expensive endeavor for someone if they want(ed) to add surgery to their treatment plate. It's also a time-consuming endeavor and gives no acknowledgement to prior training and education. I already have a DEA # and can prescribe schedules 3, 4 and 5--do I really need another whole year of pharmacology? Some of the mud slinging in the thread is laughable at best. No I couldn't go into an ED and start throwing central lines or intubate but neither could 99% of newly minted MD/DO graduates. I get your point in that a physician is made during residency. We currently have residencies in optometry--many of which do have emphasis on disease and surgical management/comanagement.

Personally I'm not even interested in surgery. I have no desire to do phaco, scleral buckle, muscle sx etc. etc. Would I do chalazion removal if it was within my scope--honestly I probably would: I've done them during training and I see enough in practice but I'm personally not feeding OD-PAC for surgical rights. As long as you guys have your collective noses in the air you're going to have turf battles and scope expansion. It's inevitable. Do you see Dentists arguing over scope expansion? Not quite. Because they have a route to go if they want to do surgery. There is a residency set in place for them to do it. I mean there are dentists doing blepharoplasties--without an MD degree! Google them they're not hard to find.

You can't suppress and try to control an independent profession--but you could work with us. I can't help but think that if an appropriate bridge program existed non of this mess would be an issue. Give the renegades an outlet. During medical school many students often times change their minds as to which specialties that he/she is interested in. Well the same could be said about optometry students.

I have respect for all medical professionals. By stating diabetes is easy to diagnose I'm merely telling truth. Sorry, Zeke but I think some of your colleagues agree with me. With that said I still get a little anxious whenever I prescribe diamox or oral pred. And I will continue to.



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[peter2013]

Typical SDN battle of the egos with the conversation not getting anywhere.

The fundamental question for optometrists looking to expand their scope of practice is why not consult ophthalmology for a surgical procedure? IMO, what it boils down to is their desire to increase profits.

They should be honest about this. And in truth, I would be okay with optometrists performing surgery if they met the minimal surgical requirements ophthalmologists need to become certified. While no study has determined the minimum number of procedures required to become proficient at given procedure, a consensus among ophthalmologist who regularly perform and teach these procedures came up with a minimum requirement to be board certified. The same requirement should be applied to optometrists.

On a side note, what puzzles me most is how a group who doesn't regularly perform procedures wants to regulate itself on those procedures.

 

[Slide]

My experience so far as a resident almost done with training? I've had to clean up enough optom-related messes in the ER and clinic to say that surgical expansion is very dangerous for patient care. I respect what optometrists do and how they can work with ophthalmologists, but there are just too many that I've experienced that do not have the adequate clinical training to correctly manage patients, much less provide the adequate level of care necessary. For instance, sending a patient urgently via ambulance to the ER for a "bilateral CRVO" is improper care for a patient with the early stages of PDR, not to mention a huge waste of health care dollars. Or, excising a "conjunctival cyst" in a patient with a trabeculectomy would, in my opinion, be grounds for malpractice. Another good one was "unilateral glaucoma case" that proved to be an optic nerve meningioma.

I do agree optometry has a role in eye care, but the scope issue is really a grab for more money for its over-saturated field. The law field has already gone through this, with an oversaturation of lawyers, and now we have a litiginous environment simply to make sure several lawyers can justify their pay. Optometry is trying to head for a similar path, and the true losers are patients.

 

[DrZeke]

When I originally posted over here I wasn't trying to start a flame war--I actually presented an idea or a thought. However no one wants to actually answer me. I shouldn't say that I consistently get the "go to medical school do the full residency etc etc." that's an expensive endeavor for someone if they want(ed) to add surgery to their treatment plate.

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I think I did answer you indirectly:

No. You shouldn't be treating primary care issues. I think you oversimplify the complexity of treating certain things. If you think I'm silly and diabetes is simple thing to diagnose and treat, that's fine. I disagree.

Why shouldn't you be an optometrist and a primary care provider on the side? Because managing primary care issues are outside of your scope of practice, whether or not you took a class on them in optometry school. To be more specific, no I don't think you should be starting patients on blood pressure meds, statins, proton pump inhibitors, antibiotics and so on pertaining to primary care problems.

I just spent a year learning how to manage and care for all the major bread and butter issues in internal medicine. As an ophthalmologist I will defer decision making on these issues to my internal medicine colleagues. If you don't understand why, then I have nothing else to say.

 

[OPPforlife]

Guys it was a Saturday night--weren't there better things to do than argue with an Optometrist?


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I was on call delivering babies bro


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[DrVinzKlortho]

I was on call delivering babies bro


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That's cool I was on call making em.


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[LightBox]

Solution for Optometry field: cut the # of graduates you pump out by half.

Solution for DrVinzKlortho/Shrunek: buy a Corvette/Porsche to help get over that inferiority complex.

Thanks.

 

[MeetJoeBlack]

That's cool I was on call making em.


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You may be able to make babies, but you can't deliver them and certainly don't how to treat them, doctor. Nor should you.

 

[long]

So, I took a look at the curriculums of a number of optometry schools and I didn't see a single one that demonstrated classwork on par with those found in the first two years of medical school.

Also, I have a friend who went to medical school after optometry school, and who is now training to be an ophthalmologist, and I have asked him point blank to compare his knowledge from optometry school to that found in ophthalmology, and his words were "it doesn't even come close".

 

[ASDA DDOC]

Dr. VinzKlortho-hope you are still reading.

I think you ask some legitimate questions about the current and future role of optometry. And I think you received some legitimate answers and valid concerns regarding safety, turf and income. The idea of a "third" pathway has been proposed in these forums repeatedly.

See Dr. Doan's link: http://forums.studentdoctor.net/threads/uniting-ophthalmology-and-optometry.197548/
See linevasel's link: http://forums.studentdoctor.net/threads/a-modest-proposal-od-omd-training-as-3rd-way.1032560/

I think that most of the OMDs on this thread really have no clue what you spend 4 years studying in optometry school, nor can we fathom how your OD program teaches you medicine without the "in-the-trenches" inpatient rotations of 3rd and 4th year. It's not an insult, we just don't know. You suggest that in many important ways the training might be equivalent. But the OD, OMDs, who have passed through both types of training who have from time to time commented on these threads strongly disagree with your assertion. But that is beside the point. I think what you are acknowledging is that unfortunately, there is a ceiling on optometric scope of practice and yes... legislatively that ceiling can be pushed, but we can all admit, that the motivation to expand scope legislatively comes about because there is no other described pathway to go from being an optometrist to being an ophthalmologist other than going to med school. I think what I would like to see is more optoms pushing for a third pathway, involving USMLE licensure. If you are a optometrist who can knock out a 260 on ur step 1 and step 2, and somehow learned enough medicine in OD school to survive PGY-1 year in medicine or surgery. Then hell yeah, I wan't you on the squad. But what I find dissapointing is that I hear more noise from optometry about expanding scope legislatively and less agitation for third pathways and access to "medical/surgical" training to be determined by appropriate qualifying testing bodies.

I mean, do I have a point here? Doing med school might not seem like an option for you at your age. And I'm not tryign to be offensive, but there are no shortcuts and there shouldn't be to this profession. Very few ophthalmologists feel their medical training was in vain. If optom has some overlap with med school maybe 4 years is overkill. But there has to be a training / qualifying period before moving on to surgical management/training. And there are number of docs who did med school, didn't match optho, trained in IM, practiced for a few years, got a spot in ophtho finally and re-trained to become eye surgeons. They did it. No shortcuts. We want you and other likeminded optoms (after all it only enahces our profession to have smart, ambitious surgeons) but we want you to join without the shortcuts. I mean doesn't that seem fair to all parties, you get more training, no one questions your background, you are accepted by your peers, and we separate those who desire expansion from those who are "capable" of expansion.

 

[mydodger]

I heard there is a new bill that will allow ophthalmic assistants to prescribe glasses and contact lenses to help lower prices...Just kidding

While the current establishment in ophthalmology is relatively safe and secure, well-insulated from such changes, those of us beginning in ophthalmology better take notes from our optometric colleagues. While most of us are sitting back in a cordial manner, failing to find effective counter-measures, optometrists are making big strides out of optometry and into medicine and surgery. I don't know the answer, but ophthalmologists, especially the establishment which carries most of the clout, better band together and start playing ball.

So as I sit here on this beautiful Sunday morning about to drink a cup of French-pressed coffee I can't help but picture you guys last night--sitting, venting. Guys it was a Saturday night--weren't there better things to do than argue with an Optometrist? Your arguments remind me of people in the olden days that rejected heliocentricism.

Well "Dr"Vinz, take the above comments to heart. Right now your profession is continually lobbying for widening of your scope of practice, and all of us young Ophthalmologists are watching.

That may have been a joke about OAs prescribing, but if Optometry continues to push scope I have no doubt that we will rally behind our Techs and push their scope. Because they have the good sense not to think they're physicians. Ever heard "Ophthalmic Technician Physician"? No, because they're not idiots. Maybe there aren't too many schools for techs right now, but the ones that exist are usually associated with an actual Medical School. And I'll bet we could train a crapton more COTs and COMTs real quickly. Is a COT or COMT's training anywhere near that of an Optometrist? Heck no. And once again, that's why we respect our Optometric colleagues. But while I've never met an Optometrist who thought scope expansion was a great idea, I've also never really met one outside of an Ophthalmology/Optometry joint practice. Is it a COT or COMT's training good enough to prescribe glasses and maybe even some drops? Well if the board of Optometry in Louisana says that Optometrists are surgeons, then our Techs can argue and lobby with your same logic. "We are trained enough."

So maybe you're sitting there on your throne with your french press, but the writing is on the wall. And Optometrists don't win this battle, friend. Want to see cheap eye care? Let the techs do it. Good luck beating them out when Wal-Mart and the clinic right next to Lenscrafters are hiring.

If you want to save your profession, stop lobbying for scope.

And start lobbying for your schools to be closed down and for your numbers to be controlled. Your own organizations are killing your profession while you're busy trying to prove that you're something you're not: a Physician.

 

[DrVinzKlortho]

Well "Dr"Vinz, take the above comments to heart. Right now your profession is continually lobbying for widening of your scope of practice, and all of us young Ophthalmologists are watching.

That may have been a joke about OAs prescribing, but if Optometry continues to push scope I have no doubt that we will rally behind our Techs and push their scope. Because they have the good sense not to think they're physicians. Ever heard "Ophthalmic Technician Physician"? No, because they're not idiots. Maybe there aren't too many schools for techs right now, but the ones that exist are usually associated with an actual Medical School. And I'll bet we could train a crapton more COTs and COMTs real quickly. Is a COT or COMT's training anywhere near that of an Optometrist? Heck no. And once again, that's why we respect our Optometric colleagues. But while I've never met an Optometrist who thought scope expansion was a great idea, I've also never really met one outside of an Ophthalmology/Optometry joint practice. Is it a COT or COMT's training good enough to prescribe glasses and maybe even some drops? Well if the board of Optometry in Louisana says that Optometrists are surgeons, then our Techs can argue and lobby with your same logic. "We are trained enough."

So maybe you're sitting there on your throne with your french press, but the writing is on the wall. And Optometrists don't win this battle, friend. Want to see cheap eye care? Let the techs do it. Good luck beating them out when Wal-Mart and the clinic right next to Lenscrafters are hiring.

If you want to save your profession, stop lobbying for scope.

And start lobbying for your schools to be closed down and for your numbers to be controlled. Your own organizations are killing your profession while you're busy trying to prove that you're something you're not: a Physician.

Nobody wins this battle. I understand and agree with some of your points. However:

Encroachment is something that is happening in all areas of medicine--this concept isn't unique to Ophthalmology. Whether it's CRNAs/AAs, NPs, PAs, DPMs (although I wouldn't consider them mid-levels), etc. all providers in some way, shape or form have some practitioners looking for a bigger piece of the pie. The DOs were smart they created an outlet for renegade PAs. Instead of these sharp PAs using their energy towards independent practice or a name change they did a 3 year DO program and the results have been pretty good. I don't have the study but apparently their board scores were exceptional.

Rallying behind your own techs for pushed scope is extremely foolish for a variety of reasons. Look at NPs and PAs for example: NPs have pushed for increased scope and independence. PAs are pushing for a name change and independence. Surely COMTs/COAs would evolve into independent practice in these locations and further flood an already saturated field. Of course they're not called technician physicians. Because right now they're technicians. They don't get a doctorate degree. Most don't even have a BA/BS. The whole concept of "optometric physician" wasn't invented for fevered egos but for a more practical purpose: to bill Medicare and other medical third party payers. Never once in any of my posts have I used the term physician to describe myself or my optometric colleagues.

I agree that schools need to be burned to the ground. I'm just as confused by the AO(ptometric)A's agenda as you guys are. Sometimes I can't help but feel that they want to saturate the market. Strength in numbers maybe? More members to pay dues? I don't know I honesty don't get it. Obviously the AOA can't single-handedly close a bunch of schools--but they can publish the long awaited man power study that they've been sitting on for almost a year now. The results aren't great--they're looking for ways to taint the data (IMO).


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[mydodger]

Instead of these sharp PAs using their energy towards independent practice or a name change they did a 3 year DO program and the results have been pretty good. I don't have the study but apparently their board scores were exceptional.

Those bridge programs have gone pretty well as far as I know, too. But just to start this discussion up again: OD to MD transition is a much more difficult issue. There will never be a guaranteed OD to OMD without going through the match, and I have no doubt that even if we found a way to knock a year off of medical school for ODs going MD, there would be a lot of unhappy campers.

In general the DO programs seem more flexible with how they deliver medical training so I'm not surprised that they were first on board for programs like this though. I should point out, however, that the thing that made DOs so unaccepted was that they used to be a lot farther from MD training than they are now. At this point we have neared such an equal level of training that I don't know any MDs my own age who feel our DO colleagues are less prepared for residency than we are. And most DOs I know wish they spent a lot less time learning muscle manipulation and HVLA since most of it is pseudoscience.

I say that to illustrate the reason why we get into pretty much all of our arguments. Because we don't think that some other type of provider has an equivalent and acceptable level of training when compared to MD (and now DO) training.

Rallying behind your own techs for pushed scope is extremely foolish for a variety of reasons.

I agree that it would be extremely foolish as well as extremely short sighted for all of the above mentioned reasons. And I'm not even meaning to say that I agree that it should be done at all. However, when the AAO gets pushed far enough and the whole "surgery by Surgeons" campaign and fund-a-thon keeps failing, they'll try anything to get some control back into the hands of physicians. Not for nefarious reasons, just because that's what almost every physician thinks is best. And if they have to create a future problem to get some leverage; I guarantee they'll do it or something like it. Because lets be frank here, OD campaigning is not about what's best: we all know that we don't need any more eye surgeons in the USA, just like we all know that nobody else needs prescribing rights for hard contacts or Timolol in the USA. The AAO and AMA will figure out sooner or later that they are the only ones lobbying for what they think is absolutely the best and safest for patients, and they'll start lobbying with different arguments.

The whole concept of "optometric physician" wasn't invented for fevered egos but for a more practical purpose: to bill Medicare and other medical third party payers. Never once in any of my posts have I used the term physician to describe myself or my optometric colleagues.

I didn't mean to sound accusing to you in particular, just to the overall misuse among many providers. Everybody on this board has a sign in town marking the location of their "Optometric Physician." The misuse of the word "physician" is something that ticks off us MDs and DOs, but it's more than about ego - we defend it because we need an identity as a profession, and that is being systematically taken away from us. Every mid-level association is pushing to become physicians without physician-level training. We have "doctors" of nursing practice. We need an identity and the word "physician" like the word "doctor" is something that we should all feel strongly about. If opticians started calling themselves "Fitting Optometrists" you'd be pretty pissed and rightly so because it is misleading to the public. Pretty soon we'll be putting up signs that say "EYE DOCTOR AS IN REAL FREAKING MEDICAL DOCTOR." Next AAO campaign will be "Ask you eye doctor if he or she went to medical school or optometry school, and know the difference!" Nobody should be having to do so much to protect their profession's title, and more than that it shouldn't be so upsetting to every other type of healthcare provider when we defend our title.

 

[KHE]

I think you guys are making too big a deal out of this. As an optometrist, I've comfortable working around the eye. Last month I took a 4 day wet lab on trabeculectomies and I did four on cadavers and four on cow eyes.

Yesterday I did my first on a live human and it went great! I saw her this morning and her pressure was 1. It doesn't get much lower than that! I'll bet you guys couldn't do much better than that!

Glaucoma cured!!

 

[DrZeke]

I think you guys are making too big a deal out of this. As an optometrist, I've comfortable working around the eye. Last month I took a 4 day wet lab on trabeculectomies and I did four on cadavers and four on cow eyes.

Yesterday I did my first on a live human and it went great! I saw her this morning and her pressure was 1. It doesn't get much lower than that! I'll bet you guys couldn't do much better than that!

Glaucoma cured!!

LMAO

 

[KHE]

LMAO

I did my second one yesterday and today the pressure was 61. That's bad, right? What do I do now?