WHy are there so few optometry schools?

[Ben Chudner]

I notice our friend Ben Chudner hasn't gotten in on this thread...hmm?...

I was going to stay quiet on this one, because a lot of what I believe has been already said, but since you have called me out, here goes.

The intentions of InfantSee are noble, however, I have to agree with those that believe we shouldn't give the exam away. I am an InfantSee participant, but I have not actively tried to promote it. If I happen to get someone who is interested in it, I will provide the service because in my area this may be the only way to get some parents to bring in their child. I am sure I will never see that child again unless there is a significant problem due to the cost of my exam. There are much better ways to promote eye care to children without giving away eye exams, but the AOA does not want to invest the kind of money that would be required to mount an effective PR campaign. That's my opinion, and based on the previous debate that went before, I see no reason to discuss it further.

As for getting onto insurance panels, I agree with Ken (KHE) that it is important, but there are several factors that contribute to a successful practice. I do not believe that the single most important factor is whether or not you can get onto medical plans. In California, for example, OD's have a very difficult time getting onto to these plans yet I know several practices that do well over a million a year. There are a ton of OD's there and for the most part they do very well in that environment even without the ability to get onto medical plans.

Relying on optical for a large portion of revenue is something that scares me, but again, several docs I know do very well that way. California proves that again. In my area, that type of practice is destined to remain small, but in other areas it works just fine. In California, where patients will spend $500 on a frame, optical sales can dramtically help a practice. It's all about the area in which you live and generalizations don't necessarily work all the time.

As for more training, gsinccom, you have the wrong attitude. Optometry should be the gatekeeper into the medical system. We should provide primary care and refer to specialists for secondary and tertiary care. Without a solid understanding of underlying systemic diseases that affect the eye we do not have the appropriate knowledge base to make the types of decisions necessary to play that role. No one is saying we need to be trained exactly as an MD, but to learn about diabetic retinopathy without understanding diabetes mellitus prevents us from appropriately caring for our patients. How can we communicate with our patients' MD's if we do not have the same level of understanding of their condition? If you want to spend all day "spinning and grinning" without following patients with systemic disease, then your education will be fine. If you want to care for the whole patient, not just the eyes, then our current system needs to be fixed.

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[Opii]

If people want to hand out Eye Exams for free they should go about it in the right way. AOA should be taught this method rather than making up the rules themselves (which seems to be a common thing optometry does). Check out the two attachments. If the doctor fills these government forms out, the doctor gets paid for their services by the gov't not the patient (patient must be poor), so the patient gets their meds, and the OD doesn't get stuck with the bill.

Rich kids should have their rich daddys / mommies pay the bills.

About Vosh, yea the intentions are good but there is a lack of follow up. And not only that. ..When the volunteers that are not doctors are doing the exams, such as the many times they consider a patient examined with an autorefractor and just rushes the patient over to dispensing without an OD looking at their fundus, that is just down right unethical. And for those Voshers out there you know it happens all too often. It's all about the numbers.

There are a few ethical groups out there who do yearly follow ups and permanent clinics, a few that come to mind are...

JEREMIE, HAITI
Haitian Health Foundation has a multi-disciplinary permanent clinic with a separate, modem eye care facility.
Optometrists can be accommodated any week of the year. Housing is provided. Dr. Robert Pannone of CT 860-887-2060 [email protected]

APOPA, EL SALVADOR
Dr. Ken Henderson of Bellingham, WA, a member of VOSH-Northwest is in the process of establishing a permanent
clinic in Apopa, EI Salvador.

SANTA ANA, EL SALVADOR (ASAPROSAR)
A well-equipped, multi-disciplined facility founded by Dr. Vicki Guzman. VOSH is encouraged to use these facilities.
Patients receive follow-up care and cataract surgery. A computerized recycled eyeglass program is intact and an optical
laboratory is onsite.

JUTIAPA, GUATEMALA
"In April, 2004, VOSH-PA officially opened the Vincent Pescatore Eye Clinic in the Peten jungle region of Guatemala.
This facility employs 30 Guatemalans including four surgeons and two optometrists and is largely funded by grants
obtained by the chapter.

ENSENADA. MEXICO
Optometrists and opticians wanted to work weekends/several weeks at the eye clinic/Eye Glasses Recycling Center, recently located in Ensenada.

GUANAJUATO, MEXICO
After a VOSH trip in 1998, the Eye Care Center in Guanajuato, Mexico was formed in conjunction with Indiana School
of Optometry

 

[Opii]

Glad to see nobody missed litt'l ol me.

 

[KHE]

I wasn't clear about this. I was talking about an office being a successful "primary care" office.

Dr. Chudner is basically correct. There are practices out there that do well relying very heavily on optical sales. However, I believe these practices are on a very precarious perch. If you are relying heavily on optical sales, you are essentially competing with commercial interests. And I think that that is a battle that a solo or even a small group practice is destined to lose.

Open a "high end" boutique type optical you say? Sure. You can do that. But why spend 8-9 years of post secondary training and hundreds of thousands of dollars if your ultimate goal is to open an eye glass store? You don't need all that training to do just that. If you're going to run an eyeglass store, you might as well save yourself all that heartache and just become an optician.

I was going to stay quiet on this one, because a lot of what I believe has been already said, but since you have called me out, here goes.

As for getting onto insurance panels, I agree with Ken (KHE) that it is important, but there are several factors that contribute to a successful practice. I do not believe that the single most important factor is whether or not you can get onto medical plans. In California, for example, OD's have a very difficult time getting onto to these plans yet I know several practices that do well over a million a year. There are a ton of OD's there and for the most part they do very well in that environment even without the ability to get onto medical plans.

Relying on optical for a large portion of revenue is something that scares me, but again, several docs I know do very well that way. California proves that again. In my area, that type of practice is destined to remain small, but in other areas it works just fine. In California, where patients will spend $500 on a frame, optical sales can dramtically help a practice. It's all about the area in which you live and generalizations don't necessarily work all the time.
.

 

[xmattODx]

There are a few ethical groups out there who do yearly follow ups and permanent clinics, a few that come to mind are...

That come to mind? Plagarism = bad

http://www.vosh.org/documents/vpermanent3.pdf

 

[gsinccom]

As for more training, gsinccom, you have the wrong attitude. Optometry should be the gatekeeper into the medical system. We should provide primary care and refer to specialists for secondary and tertiary care. Without a solid understanding of underlying systemic diseases that affect the eye we do not have the appropriate knowledge base to make the types of decisions necessary to play that role. No one is saying we need to be trained exactly as an MD, but to learn about diabetic retinopathy without understanding diabetes mellitus prevents us from appropriately caring for our patients. How can we communicate with our patients' MD's if we do not have the same level of understanding of their condition? If you want to spend all day "spinning and grinning" without following patients with systemic disease, then your education will be fine. If you want to care for the whole patient, not just the eyes, then our current system needs to be fixed.

Thanks for your voice.

Does the AOA consider this to be a priority? What is the AOA focusing on now and do they just not have the proper focus? How soon could this happen? Which schools in your opinion, do the best job of this now? Is a residency helpful for this? I am not in favor of making the Optometry curriculum any more rigourous/time consuming than it is(or why shouldn't we just go to MD school and try to match into an OMD residency?)...i.e., what could be cut out of the current curriculum to allow for these "neccessary changes" to be added. I stand by my original position a bit when I say that PAs, Chiros, and Dentists(or other health related professions that don't go through the traditional MD/DO plus internship/residency model) are primary care providers that don't have some of the same battles that we have and they don't have the broad scope of training you are suggesting do they? I'm just trying to look at this as sacrifices vs. rewards. Will the addition to the training make it all worth it in the long run? You, yourself see a lot of medical optometry and you went through the curriculum as it is now...how were you able to gain the medical expertise?

Thanks again.

 

[gsinccom]

One has very little power. It takes many to implement change. Step 1 is always to be educated. I'm near the end of step 1. I'll let you know about steps 2 through X as I do them.

The profession of optometry is not a failure. We do, however, pursure failure. Continued scope expansion will be our doom. Mark my words.

Hi again Matt,

I'll try again. Would you please explain why this would be the doom of the profession. Is it just a matter of misplaced priorities?

Thanks

 

[xmattODx]

Hi again Matt,

I'll try again. Would you please explain why this would be the doom of the profession. Is it just a matter of misplaced priorities?

Thanks

In my not so humble opinion the pursuit of scope expansion is not only misplace priorities but it opens the door to retribution from the other two O's.

Misplaced Priorities: We have far greater concerns than scope expansion. One of which is the need for open licensure. That is the ability to move state to state without having to meet asinine requirements to be licensed in that state. For this to happen we need equal legislation throughout the states. This will require the progressive states to hold off on their pursuit of scope expansion.

Ophthalmology: As we pusure more and greater scope expansion the OMDs, rightfully, become angry. As has been said before we have very little understanding of medicine - why, therefore, should we try to practice it? This, to me, is what scope expansion is - the pursuit of the right to practice medicine. As OMDs as a group get more angry we start to stand on dangerous ground because they will support Opticians.

Opticians: as we move away from traditional optometry someone needs to fill that gap. Refracting opticians will do that. They will organize and require their two year degree. They will then refract, followed by the realization that there is more to a prescription than a manifest refraction. This will lead them into the consideration of binocular vision etc. They will be the non-medical optometrist of today. We will be squeezed out on both sides. Limited in our "medical" practice by the OMDs and replaced by the opticians on the other side.

Is this just the opinion of a cynic? Yes. Will it ever come to pass? Why wouldn't it. If you look at the mindless pursuit of scope expansion that is occurring in most states it seems plausible.

 

[Ben Chudner]

I wasn't clear about this. I was talking about an office being a successful "primary care" office.

Dr. Chudner is basically correct. There are practices out there that do well relying very heavily on optical sales. However, I believe these practices are on a very precarious perch. If you are relying heavily on optical sales, you are essentially competing with commercial interests. And I think that that is a battle that a solo or even a small group practice is destined to lose.

Open a "high end" boutique type optical you say? Sure. You can do that. But why spend 8-9 years of post secondary training and hundreds of thousands of dollars if your ultimate goal is to open an eye glass store? You don't need all that training to do just that. If you're going to run an eyeglass store, you might as well save yourself all that heartache and just become an optician.

I completely agree with the above. My point was simply that there are a lot of offices that make this work, but I think it is very location specific. In my area, as I said, I cannot have a high end optical and so I would have to compete with the big boxes. That is why I have chosen to rely more on services rather than materials. I have friends in Orange County and Beverly Hills that have very successful medical practices with high end opticals. I think they would tell you they make a lot of money on the optical side.

 

[Ben Chudner]

Thanks for your voice.

Does the AOA consider this to be a priority? What is the AOA focusing on now and do they just not have the proper focus? How soon could this happen? Which schools in your opinion, do the best job of this now? Is a residency helpful for this? I am not in favor of making the Optometry curriculum any more rigourous/time consuming than it is(or why shouldn't we just go to MD school and try to match into an OMD residency?)...i.e., what could be cut out of the current curriculum to allow for these "neccessary changes" to be added. I stand by my original position a bit when I say that PAs, Chiros, and Dentists(or other health related professions that don't go through the traditional MD/DO plus internship/residency model) are primary care providers that don't have some of the same battles that we have and they don't have the broad scope of training you are suggesting do they? I'm just trying to look at this as sacrifices vs. rewards. Will the addition to the training make it all worth it in the long run? You, yourself see a lot of medical optometry and you went through the curriculum as it is now...how were you able to gain the medical expertise?

Thanks again.

You are welcome. I have no idea what the AOA's priorities are. Typically, the west coast is under represented in the AOA, so I am not very involved on a national level. The schools, however, have made positive changes to the curriculum to more closely model the medical school approach. There is still lot that needs to be done.

As for other health professions, I do not believe we should look at them in order to decide what is best for us. They have different battles than we do. We need to gain more respect in the medical community, and simply saying that we do as much as other allied professions will not help us. We need to be better. And by the way, I have no idea what dentists, chiros, etc go through. They may do much more intensive systemic learning than us.

You are right in that I see a lot of medical optometry which is very relative. It wouldn't seem like a lot to an OD working in a hospital setting. I trained at Berkeley where the curriculum was pitiful for disease. That's why I completed a residency at an ophthalmology training hospital. We spent a year working in the clinics with the OMD faculty, going to grand rounds, FA conference, etc. I gained an understanding of the eye and systemic disease that I would never have gained elsewhere. It has allowed me to work closer with the MD's in my town to the point where the PCP's refer diabetics to me for ocular evals. It has a lot to do with the fact that I can effectively communicate with them which contributes to better patients care.

 

[gsinccom]

In my not so humble opinion the pursuit of scope expansion is not only misplace priorities but it opens the door to retribution from the other two O's.

Misplaced Priorities: We have far greater concerns than scope expansion. One of which is the need for open licensure. That is the ability to move state to state without having to meet asinine requirements to be licensed in that state. For this to happen we need equal legislation throughout the states. This will require the progressive states to hold off on their pursuit of scope expansion.

Ophthalmology: As we pusure more and greater scope expansion the OMDs, rightfully, become angry. As has been said before we have very little understanding of medicine - why, therefore, should we try to practice it? This, to me, is what scope expansion is - the pursuit of the right to practice medicine. As OMDs as a group get more angry we start to stand on dangerous ground because they will support Opticians.

Opticians: as we move away from traditional optometry someone needs to fill that gap. Refracting opticians will do that. They will organize and require their two year degree. They will then refract, followed by the realization that there is more to a prescription than a manifest refraction. This will lead them into the consideration of binocular vision etc. They will be the non-medical optometrist of today. We will be squeezed out on both sides. Limited in our "medical" practice by the OMDs and replaced by the opticians on the other side.

Is this just the opinion of a cynic? Yes. Will it ever come to pass? Why wouldn't it. If you look at the mindless pursuit of scope expansion that is occurring in most states it seems plausible.

Thanks Matt.

Ben, KHE...do you guys have any thoughts on this? I mean am I as a future OD going to be squeezed out of a job by OMDs and refracting opticians. I've got the next 30 years to plan for-my career and all...and this kind of talk has us pre-ODs shaking in our boots.

why can't we as ODs come to a working agreement with OMDs and opticians or can we and how can it happen?

 

[Opii]

That come to mind? Plagarism = bad

http://www.vosh.org/documents/vpermanent3.pdf

That's not plagerism. I'm just proving my point. Plagerism is when something that is copywrited is copied for financial benefits.

Stick to Optometry. Law doesn't suit you.

 

[cpw]

Thanks Matt.

Ben, KHE...do you guys have any thoughts on this? I mean am I as a future OD going to be squeezed out of a job by OMDs and refracting opticians. I've got the next 30 years to plan for-my career and all...and this kind of talk has us pre-ODs shaking in our boots.

why can't we as ODs come to a working agreement with OMDs and opticians or can we and how can it happen?

They've been talking about refracting opticians off and on for tons of years. Opticianry would have to get stricter licensing standards to have this happen. it is a possibility, but I don't believe the AOA and AMA would let it happen. (their lobby is much stronger)

People were saying the same things before I started school... and before my friend's parents started school. Optometry is still here.

 

[Ben Chudner]

They've been talking about refracting opticians off and on for tons of years. Opticianry would have to get stricter licensing standards to have this happen. it is a possibility, but I don't believe the AOA and AMA would let it happen. (their lobby is much stronger)

People were saying the same things before I started school... and before my friend's parents started school. Optometry is still here.

I agree. It will take more than refracting opticians (if they ever get that law passed) to affect optometry. Remember, they said the same thing with refractive surgery, but we are still here.

 

[xmattODx]

That's not plagerism. I'm just proving my point. Plagerism is when something that is copywrited is copied for financial benefits.

Stick to Optometry. Law doesn't suit you.

Well since I've taken this thread so far off track it will never make it back I might as well keep it off track.

Plagiarism
The act of appropriating the literary composition of another author, or excerpts, ideas, or passages therefrom, and passing the material off as one's own creation. (taken from http://ucblibraries.colorado.edu/about/glossary.htm)

 

[gsinccom]

why can't we as ODs come to a working agreement with OMDs and opticians or can we and how can it happen? couldn't it be a win-win for all if it was handled properly?

 

[Tom_Stickel]

why can't we as ODs come to a working agreement with OMDs and opticians?...

Journalism 101: Follow the money...

 

[darling]

That's not plagerism. I'm just proving my point. Plagerism is when something that is copywrited is copied for financial benefits.

Stick to Optometry. Law doesn't suit you.

Interesting. Wonder if my professors will take that excuse if I tell them I'm receiving no financial benefits?

 

[Opii]

You all are idiots. I doubt VOSH would care if I quote them to argue in their favor. This mentality is what is screwing up optometry. People like you all bitching about stupid things.

 

[Opii]

Plagiarism
The act of appropriating the literary composition of another author, or excerpts, ideas, or passages therefrom, and passing the material off as one's own creation.

Here is a cut and paste on your definition of Plagiarism. OHHHH its exact. YOu Matt are a PLAGERIST !!!

 

[xmattODx]

Plagiarism
The act of appropriating the literary composition of another author, or excerpts, ideas, or passages therefrom, and passing the material off as one's own creation.

Here is a cut and paste on your definition of Plagiarism. OHHHH its exact. YOu Matt are a PLAGERIST !!!

Hey man,

Sorry if I offended you, but I did cite my reference

 

[Opii]

Hey man,

Sorry if I offended you, but I did cite my reference

YOu lack the copywrite date and author. So you are still a plagerist.

 

[KHE]

Thanks Matt.

Ben, KHE...do you guys have any thoughts on this? I mean am I as a future OD going to be squeezed out of a job by OMDs and refracting opticians. I've got the next 30 years to plan for-my career and all...and this kind of talk has us pre-ODs shaking in our boots.

why can't we as ODs come to a working agreement with OMDs and opticians or can we and how can it happen?

I basically agree with Matt.

Optometry is in a tough situation because it tries to "push up" on one profession while "pushing down" on another.

WHile it is true that in many states, opticianry is a non-licensed field. But there are just as many states that have extensive examination and licensing requirements for their opticiains. If these people as a group want to gain refracting rights, what is optometry going to say? Likely they will say that opticians lack the necessary training, and that public health will be put at risk.

But that's the exact same (incorrect) argument that ophthalmology made all those years ago. Are we going to make the same one? Gonna be tough to make that one stand.

So unlike Drs. Chudner and CPW, I view refracting opticians as a very real threat to the profession IF.....optometry continues to rely on material sales as the primary revenue generator in private practices which it is for 85% of the practices out there. Whether we do that through medical optometry or vision therapy, or whatever.....something other than selling glasses.

I think that most pre opt and optometry students really have no idea just how much revenue is generated from material sales in the typical private practice out there.

I do not view laser surgery or other refractive surgeries as strong threats.

In general, I do not foresee the complete elimination of optometry. But I do think that the future of the optometric profession is much like pharmacy. That is, the overwhelming majority of optometrists will end up working in retail environments. There will be a few who work in hospitals, or institutional settings, and even a few independants, but most will be in commercial environments.

How can this be stopped.....see above regarding the generation of revenue from material sales.

 

[Ben Chudner]

So unlike Drs. Chudner and CPW, I view refracting opticians as a very real threat to the profession IF.....optometry continues to rely on material sales as the primary revenue generator in private practices which it is for 85% of the practices out there. Whether we do that through medical optometry or vision therapy, or whatever.....something other than selling glasses.

A refracting optician bill came very close to passing in Washington State, so I am very familiar with it. The arguement against the bill was essentially that patients will think they received an eye exam when in fact all they got was a glasses prescription. Whether or not this is true is up for debate, but I really believe it comes down to money. Just like OMD's don't want to give up patients to OD's through expanded scope, OD's don't want to give up patients to opticians through expanded scope. I agree with Ken in that practices like mine will not suffer too much because I do not rely too much on optical sales. The OD's that will really suffer are all of the corporate docs. I have no doubt that if a refracting bill ever passes, all of the big boxes will put in their own refracting optician with a small lane that only has a phoropter. Imagine how much dead non-profitable space will be saved that can be converted into profitable retail space. The good news is that there is enough concern that these patients won't have regular eye exams by anyone so both the AOA's (optometry and ophthalmology) will fight it.

 

[canadiancal]

A refracting optician bill came very close to passing in Washington State, so I am very familiar with it. The arguement against the bill was essentially that patients will think they received an eye exam when in fact all they got was a glasses prescription. Whether or not this is true is up for debate, but I really believe it comes down to money. Just like OMD's don't want to give up patients to OD's through expanded scope, OD's don't want to give up patients to opticians through expanded scope. I agree with Ken in that practices like mine will not suffer too much because I do not rely too much on optical sales. The OD's that will really suffer are all of the corporate docs. I have no doubt that if a refracting bill ever passes, all of the big boxes will put in their own refracting optician with a small lane that only has a phoropter. Imagine how much dead non-profitable space will be saved that can be converted into profitable retail space. The good news is that there is enough concern that these patients won't have regular eye exams by anyone so both the AOA's (optometry and ophthalmology) will fight it.

In the province of British Columbia optician refraction is close to becoming a reality. It would be the first case in North America where optometrists and OMD's would not have the exclusive rights to refraction....scary thought.
http://www.opto.ca/en/bc_cd/index.htm

 

[jefguth]

In practice...Opticians, very few of them, are refracting across Canada. While BC is the only province that doesn't require an OD or MD signing off on the refraction you can bet the opticians elsewhere are doing this pretty much independently. Also, its not only ophthalmologists that are being paid by opticians to do this, so are a number or MD's with training in other areas taking part. In my hometown there is an optician that pays an ER doc to sign the Rx and on occassion do an ocular health exam. Now I can't say I know much about the training of emergency physicians but I do thinks its a questionable arrangement.

 

[Hines302]

Great Discussion Everyone! Very Interesting Read!

I don't think we will see refracting opticians anytime soon. There has been a shortage of pharmacists for years... but yet Pharmacy Techs are not dispensing drugs on their own.

and I wouldn't say that OD's are abandoning refraction for medical optometry and leaving a niche for opticians... we all know that there is enough ODs around to do both

 

[stompy]

Great Discussion Everyone! Very Interesting Read!

I don't think we will see refracting opticians anytime soon. There has been a shortage of pharmacists for years... but yet Pharmacy Techs are not dispensing drugs on their own.

and I wouldn't say that OD's are abandoning refraction for medical optometry and leaving a niche for opticians... we all know that there is enough ODs around to do both

Hey! you decided to go to Ohio State. I heard you guys are strong in optics...

 

[Hines302]

Hey! you decided to go to Ohio State. I heard you guys are strong in optics...

Yeah I am excited. I heard the first year is a tough one.

BTW.. if anyone is going to OSU next year and needs a place to live and/or a roomate I am looking also.