Would you hire an Ophthalmic Physician Assistant?

[SportsJunkie25]

Hello all!

Like the thread title states, would you hire an Ophthalmic Physician Assistant? (http://www.eyeworld.org/article.php?sid=4529)

If so, how would their scope of practice differ from an Ophthalmic Tech or an Optometrist who can work in your practice?

Thanks.

---

Members don't see this ad.

 

[SportsJunkie25]

40 views and absolutely no one has an opinion on this? I figured this would be the perfect forum to get an answer. Why? B/c I've never really heard of an Ophth PA and was hoping you guys could help me out...

 

[flooby]

I don't see an opportunity for a PA in ophthlamology. They are not trained for eye care, refraction, or even applanation. If they were, why pay a PA salary when a COT, optom, or even an educated individual with time to spare can learn. I guess they could be surgical assistants but there are very few sutures and when there are, tying 10-0 is a lot different then what they are trained with. You don't need to be a PA to keep the cornea moist......

 

[SportsJunkie25]

I don't see an opportunity for a PA in ophthlamology. They are not trained for eye care, refraction, or even applanation. If they were, why pay a PA salary when a COT, optom, or even an educated individual with time to spare can learn. I guess they could be surgical assistants but there are very few sutures and when there are, tying 10-0 is a lot different then what they are trained with. You don't need to be a PA to keep the cornea moist......

Oh, ok. Well, yeah, that was my point in posting this thread. I didn't know what an Ophth PA could do that an Ophth Tech couldn't do (besides cost you more $$ to hire). I was wondering if I was missing something. Thanks for responding!

 

[Jokestr]

Interesting that this article was written by a "consulting agent"/businessman...not and MD. I doubt that there are too many ophthalmologists that would agree with his idea of using PA's for care. I'm sure a PA makes perfect sense to someone who has never looked at an eye, done surgery on an eye or even spent an entire day in an eye clinic.

Maybe this is why our healthcare system is in such array....people like this making decisions for us.

 

[jefguth]

Hello all!

Like the thread title states, would you hire an Ophthalmic Physician Assistant? (http://www.eyeworld.org/article.php?sid=4529)

If so, how would their scope of practice differ from an Ophthalmic Tech or an Optometrist who can work in your practice?

Thanks.

I've worked with a PA in the eye clinic at a VA. This particular PA worked part time in the clinic, mostly because he seemed to have a special interest in the eye, but frankly having him there wasn't too useful as he pretty much had to have one of the OD's/MD's check his patients. His knowledge at the time was pretty limited. He was there mostly to triage any emergency/walk in patients. Overall, slightly more helpful than an Ophthal tech.

 

[jefguth]

I've also heard of a practice in Florida that has, or rather had, a PA performing all the YAG caps.

 

[orbitsurgMD]

I've also heard of a practice in Florida that has, or rather had, a PA performing all the YAG caps.

Maybe to do preop H&P where patients cannot see their own physician or where they don't have a physician. I have seen CRNPs do the same.

Otherwise, no.

 

[jefguth]

Maybe to do preop H&P where patients cannot see their own physician or where they don't have a physician. I have seen CRNPs do the same.

Otherwise, no.

My understanding, and I've heard this from a number of people, is that this clinic used a PA to actually perform the procedure. Apparently, the supervising surgeon has discontinued this practice secondary to pressure (understandably) from his colleagues.

 

[deleted6669]

I know a very few pa's working in ophtho. most of them were ophtho techs before going to pa school. now they do pre-op h+p's and hospital d/c summaries, same day visits for minor trauma(abrasions and fb removal), surgical f/u's, glaucoma tx monitoring, etc
none of them have a role in the o.r.

 

[cme2c]

PAs didn't have roles in other specialty clinics either. Slowly they have spread into most specialties. Frankly, I agree with the article. You could easily take a PA and train them to do the simple stuff we do on a daily basis. Have a 1 year PA residency and they would be able to do a lot in the clinic, especially triage. Think of where residents entering their 2nd year are? We trust them to cover the same type stuff in the E.R. without much thought.

As for what a PA can do that a COT can't, it's called bill for services. I see this happening more and more. PAs have not yet started to go after independent surgical privileges. Maybe we as an MD community should start more PA/ARNP training programs and quit hiring ODs.

 

[Meibomian SxN]

...PAs have not yet started to go after independent surgical privileges. Maybe we as an MD community should start more PA/ARNP training programs and quit hiring ODs...

I agree with you! That way ODs could have more reason to push for surgical privileges (we could model it after cardiology & call ourselves Interventional Optometry ) thereby reducing Healthcare costs and getting a slice of ObamaCare.....

Anyways, I just read these interesting articles this morning, wonder how Primary Care feels about that (and I thought ODs had it tough fighting for turf)...

If a Health-Care Bill Passes, Nurse Practitioners Could Be Key
http://news.yahoo.com/s/time/20090803/us_time/08599191422200

http://www.msnbc.msn.com/id/30964099/
Among the top cost-savers United identified are:

• <LI class=textBodyBlack itxtvisited="1">$166 billion by providing skilled nurse practitioners at nursing homes to manage illnesses and prevent avoidable hospitalizations;
• $37 billion by steering patients to physicians rated best on quality, efficiency and cost;

 

[Oculomotor]

That's hilarious Meibomian SxN! The medical profession doing three things to destroy primary care medicine:

1) Not opening enough medical schools in the last 20 years while the supply of primary care MD/DO's does not meet the demand for primary care doctors-----> Enter (DNP's) Doctors of Nursing Practics and (MSPA's) Masters of Science in Physician Assisting.

+

2) Medical students in droves are turning away from primary care because they are more attracted by lucrative salaries and lifetyles in subsecialties.

+

3) Enter stupid, resource wasting and misplaced anti-optometry, anti-podiatry, and in some cases anti-dentistry lobbying by the AMA/ State Medical Associations (i.e. SOPP) instead of focusing their efforts on the "real" impending threat to the most important physicians out there---> primary care physicians.

+

4) Obama pushes through "nationalized" or socialized medicine

=

In 20 years the primary care physicans that are left will be sharing family medicine, etc with DNP's and MSPA's because the demand will be need more supply regarding primary care providers and restrictions on nurse practitioners and PA's will be much less that they are currently.....


Idiotic idea cme2c

 

[cme2c]

No more idiotic than an OD doing surgery, that was my point.

 

[Oculomotor]

cme2c,

If you are talking about PURE or REAL Ophthalmic Surgery then I don't disagree with you-----> we are not trained for that end. But anything such as:

1) FB removal
2) Epilation/Irrigation
3) Micropuncture
4) Rust ring removal
5) Periocular Injections, Subtenons, etc.....
6) Corneal Debridement
*7) Limited use of therapeutic lasers for things such as a YAG capsulotomy.
NOT LASIK, LASEK, or PRK.......

all of these procedures are well within the training/ abilities of O.D.'s. Number *7 should be and eventually will be in the future. Most of 1-6 is already done in most states anyways. I don't consider any of that stuff REAL surgery and the fact that ophthalomologists do (for purely financial/ political reasons)-------is IDIOTIC.........

Keep your surgery by surgeons nonsense but I (as well as many of my classmates) will fight you tooth and nail over 1-6 and *7 is in future plans.....

 

[cme2c]

We don't disagree at all. Personally, I don't consider 1-4 as surgery at all, and could care less if an OD does them. #5-7 are surgery, but I would call them minor surgery. Those would be reasonable with a certification of some sort. #7 is difficult, personally I think YAG cap would be reasonable with a weekend course and 10 or so supervised patients One of the other problems with our speciality is that there are not great "practice" models. The more difficult lasers like focal or retinopexy are little tough for me to agree to at this point. Our training programs require X procedures in certain areas. As long as anyone, OD, PA, NP can prove they were trained to a minimum standard, fine. The problem is that at least in my state everytime a new bill is introduced 1-7 are also bundled with real "surgery". That's why people fight it. So you will never get a training standard developed with cooperation between the two sides. I would guess that most MDs think 1-6 are totally reasonable for an OD, just like most ODs don't want to do cataract surgery. The problem is when the political machines get involved. I don't think it's financial at all for #1-7. They just aren't that lucrative (except retina lasers, which will change soon). It all boils down give an inch take a mile.

Still there is something to be said for having experience taking care of surgical complications. YAG capsulotomy still has risks. Experience in residency with fixing a dislocated IOL does give one a different appreciation for YAG cap. Doing a PKP on a botched LASIK does as well.

Personally, I actually have more issues with ODs prescribing certain meds. Prednisone, Diamox, Immunosuppresants, etc can be very dangerous. That is where our 5 years of general medical training really make a difference. Frankly, I hate prescribing them myself. If they are anything but a picture of health, I get their PCP involved. There aren't many communities that have ODs that don't have a primary care MD that could help with those. Yet, the bills still frequently ask for blanket privileges for oral meds.

 

[Meibomian SxN]

Personally, I actually have more issues with ODs prescribing certain meds. Prednisone, Diamox, Immunosuppresants, etc can be very dangerous. That is where our 5 years of general medical training really make a difference. Frankly, I hate prescribing them myself. If they are anything but a picture of health, I get their PCP involved. There aren't many communities that have ODs that don't have a primary care MD that could help with those. Yet, the bills still frequently ask for blanket privileges for oral meds.

So it took you 5 years to understand the mechanisms of action of Pred, Diamox etc? ODs take extensive pharm courses, not as extensive as general MD school but it definitely covers the major medicines prescribed today and certainly those prescribed within scope.

I am assuming you are a resident because I do not know of too many Ophthalmologists that are prescribing methotrexate to uveitis cases. These are rare cases that typically are referred past Primary care and to a Rheumatologist to treat the underlying disease. Swab & rinse cases with 5-FU and mitomycin hardly take 5 years of training either; no offense intended.

 

[Oculomotor]

(cme2c)

At least we have some common ground about what I was talking about but----->First off don't compare us with PA's or NP's (as useful as they are), we have doctoral level education--->we are EYE DOCTORS not midlevels (which are supervised by MD's/DO's), we are classified by social security and more recently the Joint Commission as physicians along with MD's, DO's, DDS's, and DPM's, we practice as independent doctorate level prescribers assuming 100% liability for our decisions just like MD's. I find that to be insulting (as I sit in 10 classes per semester---took 1 year of pharmacology and a semester of ocular pharmacology--and I tutor PA students in pharmacology-no comparsion with our education) Another low blow attempt by you to insult us Pleas don't collectively insult us LOL......Knock it off.....! lol How about I compare you to PA's and NP's and watch a volcano erupt on this forum? WTF

Anyway, I think that we have enough training and professional responsibility to have no restrictions on therapeutics (like dentistry within their realm). Medicine does not have a patent on "common sense" and our prescribing record speaks for itself.

I know plenty of OD's that prescribe oral steroids, oral anti-infectives, all the time. They follow the proper algorithms and protocols just like MD's, DDS's, and DPM's. Now we agree on some things (like no OD's should be performing cataract surgery, etc.....) but the 1-7 should all be in the Optometric Physician's tool box.

 

[Eyefixer]

Oculomotor, we all know your view points by now. Let me just save you some time here; you WILL NOT change any minds on this forum. Don't waste your time.

 

[cme2c]

So it took you 5 years to understand the mechanisms of action of Pred, Diamox etc? ODs take extensive pharm courses, not as extensive as general MD school but it definitely covers the major medicines prescribed today and certainly those prescribed within scope.

I am assuming you are a resident because I do not know of too many Ophthalmologists that are prescribing methotrexate to uveitis cases. These are rare cases that typically are referred past Primary care and to a Rheumatologist to treat the underlying disease. Swab & rinse cases with 5-FU and mitomycin hardly take 5 years of training either; no offense intended.

That is the problem. It does not take 5 years to understand the mechanism of action. It takes 5 years to study the kidneys, the liver, diabetes, hematology, etc. You need an overall understanding of medicine that you cannot get with "pharm courses". We are talking about life or death. You can't just learn that in a "pharm course". If you are ordering a CBC to watch for side effects, you need to know what you are looking at. If you are ordering a CMP, you need to know what a metabolic acidosis looks like. You need to know the questions to ask the patient, etc. "Pharm Course", totally laughable.

You assumption is wrong. I am an attending. I do know quite a few ophthalmologists that will prescribe their own immunosuppresants. The uveitis specialist I trained with did MTX, Imuran, CellCept on his own. The cornea guy I trained with did his own cyclosporine for graft rejection. My current retina guy does his own. They do it enough that it is in their comfort level. They had MDs and knew how to interpret the lab tests. But, if you think they should be sent to a Rheum, why do ODs need the right to prescribe them.

 

[cme2c]

(cme2c)

At least we have some common ground about what I was talking about but----->First off don't compare us with PA's or NP's (as useful as they are), we have doctoral level education--->we are EYE DOCTORS not midlevels (which are supervised by MD's/DO's), we are classified by social security and more recently the Joint Commission as physicians along with MD's, DO's, DDS's, and DPM's, we practice as independent doctorate level prescribers assuming 100% liability for our decisions just like MD's. I find that to be insulting (as I sit in 10 classes per semester---took 1 year of pharmacology and a semester of ocular pharmacology--and I tutor PA students in pharmacology-no comparsion with our education) Another low blow attempt by you to insult us Pleas don't collectively insult us LOL......Knock it off.....! lol How about I compare you to PA's and NP's and watch a volcano erupt on this forum? WTF

Anyway, I think that we have enough training and professional responsibility to have no restrictions on therapeutics (like dentistry within their realm). Medicine does not have a patent on "common sense" and our prescribing record speaks for itself.

I know plenty of OD's that prescribe oral steroids, oral anti-infectives, all the time. They follow the proper algorithms and protocols just like MD's, DDS's, and DPM's. Now we agree on some things (like no OD's should be performing cataract surgery, etc.....) but the 1-7 should all be in the Optometric Physician's tool box.

You said it, you are EYE DOCTORS. Topical medicines and Systemic Medicines have effects on other areas than the eye. You are not Kidney doctors, you are not liver doctors. An MD requires clinical experience that gives experience on the whole gamut of disorders.

I'm sorry, but as far as oral medications go, I would trust an NP or a PA over an OD. I trust them for my own patients for complicated pre-op physicals. They have more education in systemic disease than an OD. I don't care if you are a "doctor". I don't think a chiropractor should be able to prescribe everything either, and they are a "doctor". A PhD in pharmacology should not prescribe either.

Just because dentists can prescribe most meds, doesn't make it right. (I don't know enough about DPM training to make an educated response). Most states do limit them to treating only dental problems. They do not have unrestricted prescribing license. They basically stick to pain meds and antibiotics. Dentists that want to do more extensive procedures don't just do an extra year or two. They have Oral surgery programs and they are forced to do the same clincal clerkships as an MD. They get credit for year 1, year 2 of medical school, but have to complete year 3 and 4 and pass the USMLE exam. If the DDS education was sufficient they would be able to just do an oral surgery fellowship and go.

So when your antibiotics give your patient pseudomembranous colitis, do you have experience with that? How about yeast infections? Have you ever seen Steven Johnson Syndrome on the burn unit? If you don't have adequate training on the side effects, you shouldn't be able to prescribe it. That's what the MD gives you. It's not just the classroom work. It's the two years of broad clinical clerkships, and the year of internship taking care of general medical patients. It's not as simple as learning the "mechanism of action" in a "pharm course."

 

[KHE]

Oculomotor, we all know your view points by now. Let me just save you some time here; you WILL NOT change any minds on this forum. Don't waste your time.

In my 10 year career, I have probably prescribed oral steroids 3 times, all to uveitis patients and none for longer than a 3 day duration just to get them over the intial hump for topical medication be adequate.

As far as oral antibiotics, perhaps two or three times a month for low grade pre-septal cellulitis and perhaps 4 or 5 times for recalcitrant meibomianitis.

Diamox I gave once in the office for a closed angle patient who was on the way over to see the glaucoma specialist.

In other words, I think it's incredibly rare for ODs to be prescribing oral medications for long term conditions.

 

[KHE]

You said it, you are EYE DOCTORS. Topical medicines and Systemic Medicines have effects on other areas than the eye. You are not Kidney doctors, you are not liver doctors. An MD requires clinical experience that gives experience on the whole gamut of disorders.

So when your antibiotics give your patient pseudomembranous colitis, do you have experience with that? How about yeast infections? Have you ever seen Steven Johnson Syndrome on the burn unit? If you don't have adequate training on the side effects, you shouldn't be able to prescribe it. That's what the MD gives you. It's not just the classroom work. It's the two years of broad clinical clerkships, and the year of internship taking care of general medical patients. It's not as simple as learning the "mechanism of action" in a "pharm course."

This is all basically true in theory yet the fact is that the streets are not littered with dead patients who died from getting oral antibiotics, or short term doses of low strength prednisone from their ODs, dentists and podiatrists.

As such, the reasonable conclusion is that ODs (and other providers) are safely and judiciously using these medications.

 

[Oculomotor]

cme2c
In the future when DNP's and PA's are doing most of the primary care medicine----> I will send my patients to them......Like you said they are equal to MD's......cool

Your argument is weak. So are you saying that Dentists/Optometrists (similar amount of education) cannot prescribe oral systemic drugs safely and effectively? You are out of line.........The track record of drug prescribing by OD's has been exemplary in terms of safety. The one difference you forget to mention in your fabulous exhibition of hubris is that OD's/ Dentists do not treat systemic disease rather we treat an organ system. Now it doesn't take a rocket scientist to prescribe systemic meds safely just prudence and good deductive abilities. Oral prescriptions have systemic effects---DUH but as long as an OD/DDS prescribes within the scope of their training they are more than safe. We are not comparable to MD's because we DONT TREAT SYSTEMIC DISEASE------> where is the cry against Dentists who prescribe far invasive drugs (nerve blocks) and narcotics (we rarely do) than us? And the comparison with a chiropractor or a PhD is absurd----------->We are clinical doctors trained to treat pathology. You are trying again to belittle and degrade. All I know is that a survey in my home state over 2 years indicated that:

Out of the thousands of prescriptions by OD's in 2 years in the state
92% were topical ophthalmic meds
8% were oral medications
<1% were periocular

Where are the dead bodies? Why isn't the morgue lined with corpses? Where are the malpractice attorneys to feast on the evil OD's?

none, zero, nada

that's right, if you could take your head out of the proverbial medical school coolaid you would understand this. I was part of the legislative effort to add narcotics, oral steroids, in that state.....the arguments you give a tired and old-------> try a new angle.....

And yes we are the primary eye care equivalents of you.........deal with it


--- Primary Eye Care Physician----this is what a doctor of optometry is. You can bet it will be on all my business cards distributed to all the cool ophthalmologists such as yourself that will be taking my refrerrals. Yes they will accept every patient for the $$$$$$$$$$$$)

 

[Oculomotor]

And by the way CME2,

I am working my ass off to earn my Doctor of Optometry (OD) degree. I am not "like a doctor" or "can call myself a doctor".........I am going to be one.



Stop acting like an arrogant butthole.

 

[Oculomotor]

I give up on this stupid thread.........

 

[KHE]

I give up on this stupid thread.........

Thank God.

 

[cme2c]

This is all basically true in theory yet the fact is that the streets are not littered with dead patients who died from getting oral antibiotics, or short term doses of low strength prednisone from their ODs, dentists and podiatrists.

As such, the reasonable conclusion is that ODs (and other providers) are safely and judiciously using these medications.

You're right, they don't litter the streets. They show up at hospitals and are cared for by MDs. You said it yourself you rarely prescribe them. So not only do you get little training on them, you rarely use them. It is disaster waiting to happen. All it takes is one to make a difference. We don't need a street full of them.

 

[KHE]

You're right, they don't litter the streets. They show up at hospitals and are cared for by MDs. You said it yourself you rarely prescribe them. So not only do you get little training on them, you rarely use them. It is disaster waiting to happen. All it takes is one to make a difference. We don't need a street full of them.

Please. Let's be serious now.

 

[Oculomotor]

cme2c,

You obviously have an issue with Optometrists and it is personal. OD's have the lowest malpractice rates of all the doctorate level prescribers and even LOWER than your little "sidekick" PA's and NP's you oversee. ( I can furnish this data if you want) The fact is that thousands of prescriptions for oral meds are written by OD's every year across the country (47 states have these privileges). Every time I bring up Dentists (we have a similar basic science education---> I take a lot of classes with them) you have NOTHING to say. Even they have better malpractice rates than you and they DO invasive procedures. You have to be a resident because you just don't have the wisdom or the insight that the ophthalmologists I know and interact with have........The consensus of the ophthalmologsts I know and respect immensly agree that:

1) OD's are more than qualfied to prescribe oral and topical drugs within their scope of practice (to treat any disease or disorder of the visual system and its subordinate parts within the scope of primary medical eye care)

2) They should not be performing "real" ophthalmic surgery (not including FB removal, micropuncture, etc...etc....) because they are not trained to.

3) They should have access to periocular injections (not intravitreal, etc)

4) The are the PRIMARY EYE CARE SPECIALISTS in this country because they provide 75% of the primary eye care.

5) If they want to do "real" surgery then they would need a residency similar to OMFS in dentistry-----> YES they really said this!


You are just pissed because we can do 8 years of training (including undergrad) versus your 12 years and we are still Eye Doctors and have independent prescribing rights, make on average $140K --> after 5 years of practice, and the majority of the public doesn't know the difference.

Your problem is HUBRIS.....

Don't take any referrals in the future from Optometrists you hipocrate.......
but you will.....if you want to make the BIG bucks -----you will....

 

[cme2c]

cme2c,

You obviously have an issue with Optometrists and it is personal. OD's have the lowest malpractice rates of all the doctorate level prescribers and even LOWER than your little "sidekick" PA's and NP's you oversee. ( I can furnish this data if you want) The fact is that thousands of prescriptions for oral meds are written by OD's every year across the country (47 states have these privileges). Every time I bring up Dentists (we have a similar basic science education---> I take a lot of classes with them) you have NOTHING to say. Even they have better malpractice rates than you and they DO invasive procedures. You have to be a resident because you just don't have the wisdom or the insight that the ophthalmologists I know and interact with have........The consensus of the ophthalmologsts I know and respect immensly agree that:

1) OD's are more than qualfied to prescribe oral and topical drugs within their scope of practice (to treat any disease or disorder of the visual system and its subordinate parts within the scope of primary medical eye care)

2) They should not be performing "real" ophthalmic surgery (not including FB removal, micropuncture, etc...etc....) because they are not trained to.

3) They should have access to periocular injections (not intravitreal, etc)

4) The are the PRIMARY EYE CARE SPECIALISTS in this country because they provide 75% of the primary eye care.

5) If they want to do "real" surgery then they would need a residency similar to OMFS in dentistry-----> YES they really said this!


You are just pissed because we can do 8 years of training (including undergrad) versus your 12 years and we are still Eye Doctors and have independent prescribing rights, make on average $140K --> after 5 years of practice, and the majority of the public doesn't know the difference.

Your problem is HUBRIS.....

Don't take any referrals in the future from Optometrists you hipocrate.......
but you will.....if you want to make the BIG bucks -----you will....

As I have stated many times before, I am not a resident, I am an attending. I am not the one making personal assumptions. I have nothing against ODs. I share a practice with several who I get along great with. One of whom I trained under in residency. The other two are more recent grads. Both attended my undergraduate alma mater. I willfully admit that both had better GPAs there than I did. Not ashamed of that at all. We also have 4th year OD students rotate in our practice. If our ODs are gone, the OD students spend time with me, so I do have some direct insight into their level of training.

You are the one who is making this personal, and you know NOTHING about me. You are the one who brings up money, money, money. You think I want the uveitis patient that needs the oral steroids? Heck no, who in the right mind wants those? You think I want the patient that needs oral diamox? Heck no. Frankly, I got into Ophthalmology because I selfishly loved the ability to have an immediate impact on the patient. I personally hate the chronic uveitics and glaucoma patients. I love the patient POD#1 who is 20/20. I love the patient who loves her monovision contacts, the ptosis repair, etc. Nobody makes money off of the patients that need systemic meds, so money is not the motive and it's comical to claim that it is. SAFETY is the motive.

I did respond to your first response about dentists. I don't think they should have blanket privileges either, and said that. I also pointed out how their education is supplemented with the oral surgery programs that lead to an MD for those that want to do invasive procedures. The reason being their DDS education did not adequately cover the requisite systemic disease. Most oral surgery programs make their participants do full blown general surgery internships for a reason. I wholeheartedly agree that a great solution would be to have a similar program for ODs. You would still have to pass USMLE Step 1. You would have to do the clinical clerkships required by the AAMC. You would then have to pass Step 2 and Step 3. You would then do an ophthalmology residency adapted to account for your experience. This residency would be skewed more toward the surgical side in order to be shortened by a year. Low vision rotations, rotations with the ODs would be reduced.

There are lots of reasons dentists have lower malpractice rates than ophthalmologists. The primary reason being that if they screw up it can be rather easily fixed. It's pretty easy to replace a messed up tooth with an implant. Eyeballs can't be easily fixed. It has little to do with their prescribing patterns.

As for the ophthalmologists agreeing with you , what do you expect them to say to your face? Do you think they are going to tell you right then and there that they think you shouldn't be doing XYZ? No, they have to work with you. They can't afford to be honest. But, I will tell you that behind closed doors, they are ridiculing your "pharm course" where you learn the "mechanism of action" and think it prepares you to be able to truly appreciate the risk that oral steroids and the like really carry.

As for taking referrals from ODs. How is it hypocritcal? If I am better prepared to take care of a patient for a given problem than the referring OD, wouldn't it be hypocritical to turn it down and leave the patient with that doc? If the doc is referring it, he/she must think I am the person to best take care of that patient. Look up the definition of hypocrite.

 

[VA Hopeful Dr]

cme2c,

You obviously have an issue with Optometrists and it is personal. OD's have the lowest malpractice rates of all the doctorate level prescribers and even LOWER than your little "sidekick" PA's and NP's you oversee. ( I can furnish this data if you want) The fact is that thousands of prescriptions for oral meds are written by OD's every year across the country (47 states have these privileges). Every time I bring up Dentists (we have a similar basic science education---> I take a lot of classes with them) you have NOTHING to say. Even they have better malpractice rates than you and they DO invasive procedures. You have to be a resident because you just don't have the wisdom or the insight that the ophthalmologists I know and interact with have........The consensus of the ophthalmologsts I know and respect immensly agree that:

1) OD's are more than qualfied to prescribe oral and topical drugs within their scope of practice (to treat any disease or disorder of the visual system and its subordinate parts within the scope of primary medical eye care)

2) They should not be performing "real" ophthalmic surgery (not including FB removal, micropuncture, etc...etc....) because they are not trained to.

3) They should have access to periocular injections (not intravitreal, etc)

4) The are the PRIMARY EYE CARE SPECIALISTS in this country because they provide 75% of the primary eye care.

5) If they want to do "real" surgery then they would need a residency similar to OMFS in dentistry-----> YES they really said this!


You are just pissed because we can do 8 years of training (including undergrad) versus your 12 years and we are still Eye Doctors and have independent prescribing rights, make on average $140K --> after 5 years of practice, and the majority of the public doesn't know the difference.

Your problem is HUBRIS.....

Don't take any referrals in the future from Optometrists you hipocrate.......
but you will.....if you want to make the BIG bucks -----you will....

You said you were done with this thread. Lying makes Jesus cry.

 

[stonegoat]

I wonder why ODs are always so concerned about what OMDs think of them? I am an OD and couldn't care less what a particular ophthalmologist thinks of me or my training. The only thing that matters is that I take care of my patients and address their complaints. My schedule is always full....so I guess I'm doing my job.

 

[Aznfarmerboi]

I wonder why ODs are always so concerned about what OMDs think of them? I am an OD and couldn't care less what a particular ophthalmologist thinks of me or my training. The only thing that matters is that I take care of my patients and address their complaints. My schedule is always full....so I guess I'm doing my job.

I dont think any OD does, just oculomotor in this forum.

 

[Oculomotor]

Actually I don't really care what ANYONE thinks of me! Anyone that knows me personally would verify this. I do care how my colleages think of me because I care about them. I like a good arguemnt and when I hear something that is misleading or downright derisive towards something I am invloved with (ie optometry) then I feel compelled to reply...Remember this is an internet forum not the real world!

And the fact is cme2c , we have good training, safe and rigorious enough for our scope of practice-----> treating primary eye diseases with topical, oral meds, and rarely some injections. If it was not OD's would not be able to do it....plain and simple. That is the beauty of optometry, 8-9 yrs with undergrad and you are an eye doctor, you have a number of the privileges that at one time in the past were only reserved for a residency trained MD, you are the expert in refractive care, know more about hot the visual systerm WORKS than most, and you have a good living. Optometry is a great deal for the time put in.

And by the way, 80% of oral surgeons do not have an MD next to their name....Most of them have the 4 yr OMFS certificate......

3 of those ophthalmologists I know are close family friends and YES those opinions I stated are legit. They understand that optometrists are the primary eye doctors and ophthalmologists are eye surgeons and eye specialists. They could care less if I performed a periocular injection or wrote a medrol prescription to treat an ocular allergy condiiton. Times are changing for the betterment of patient access and golden age of medical monopoly is eroding. My father is a physician and I said would you have thought back in 1972 when you finished medical school that optometrists would be prescribing medications (including narcotics) , dentists would be doing cosmetic procedures (ie botox), oral surgeons would be doing facial plastics, Nurse practitioners would be postioned to be independent primary care providers, every allied health program is now a doctorate---> DPT, AuD, DNP, and yes DrPA lol.? ...........he replied, " No way, I would have said that medicine would never let that happen." Well it happened and it is happening as we speak.

 

[MAYOphtho]

Actually I don't really care what ANYONE thinks of me! Anyone that knows me personally would verify this. I do care how my colleages think of me because I care about them.

Are you saying your colleagUes are nobodys?

I personally don't have a problem with properly trained ODs doing the procedures within their scope of practice...but back to your last sentence in your rant (" Well it happened and it is happening as we speak.")...the issue isnt what ODs can currently do, it's the theory that you give an inch and lose a mile

we went to medical school for extensive privileges based on the very intricate understanding of surgical and medical issues (and complications) within the body...could ODs probably handle a few more things safely? I think they might...however, as you stated the scope of practices continue to change and at that rate ODs could continue to push for privileges they truly should not have...because of small victories that continue to build

and here comes the loud...angry response from oculomotor

 

[Eyefixer]

Are you saying your colleagUes are nobodys?

I personally don't have a problem with properly trained ODs doing the procedures within their scope of practice...but back to your last sentence in your rant (" Well it happened and it is happening as we speak.")...the issue isnt what ODs can currently do, it's the theory that you give an inch and lose a mile

we went to medical school for extensive privileges based on the very intricate understanding of surgical and medical issues (and complications) within the body...could ODs probably handle a few more things safely? I think they might...however, as you stated the scope of practices continue to change and at that rate ODs could continue to push for privileges they truly should not have...because of small victories that continue to build

and here comes the loud...angry response from oculomotor

:troll:

 

[Oculomotor]

MayOphtho,


I am not saying that OD's should have invasive ophthalmic surgery privileges without a residency program for that stated purpose. What I am saying is that your whole "give an inch take a mile" philosophy is flawed. If optometry had not decided as a profession in 1970 that they should be prescribing therapeutics to diagnose, treat, and manage eye diseases, and committed to almost 40 years of ongoing legal battles with medicine they would have never been able to evolve. Do you think they could have went to the AMA and asked," Hey AMA we want to transform our professy ion and evolve by changing some laws with your cooperation..What do you think?..." LOL I am pretty sure that the "Drug Pushing Association" er I mean the AMA would have laughed in their face. Like I said before I feel like Tennessee has the ideal scope of practice reflecting our training as it is currently constructed. Tennessee Optometry Law:

1) OD's can prescribe any medications oral, topical, or injectible to treat eye diseases within their training and the scope of primary eye care.
2) In office procedures that use local anesthetic (topical) can be performed excluding refractive surgery, etc...

I am being well trained to practice under conditions that exist in that state. One problem in the two states I will probably practice in the injections are restricted to treatment of anaphylaxis....WTF? So hypothetically if I had a patient that needed a simple injection (that I am trained to perform) instead of doing it conveniently (in a minute) for my patient I would have to send them to an Ophthalmologist (wasting their time and money, burdening insurance, and making me look ridiculous) or I could tell them to drive across the border into a state that has therapeutic injections and I could perform it there. This the type of nonsense that I blame state medical associations, the AMA, and various medical lobbying groups. Well in general they have not been successful because now all 50 states permit OD's to prescribe ophthalmic drugs and 47 allow oral systemic drugs. In 1970 it was zero. How successful do you think medicine has been in stopping this?-------------> miserabley unsuccessful.
I did not go into optometry to "operate" and I can understand from your point of view why you feel the way you do. That said I believe that the professional hubris and "god complex" exhibited by your state and national medical organizations need to change and adopt a more realistic tactic------> like working together with optometry.......THIS WILL NEVER HAPPEN.....EVER EVER EVER EVER EVER! We will fight you in the legislature + courts and work with you in the clinical setting to deliver quality eye care.



Eyefixer,

afraid of an argument that you oppose? lol you have to stoop to Dictator Obama like tactics--->"stop feeding the troll" I bet you voted for him........


Proud GOP member
2010 Midterms --vote Republican

 

[KHE]

Lying makes Jesus cry.

Wait a minute....lying makes him cry? I was always told that it was mast....

Oh, forget it!

 

[Eyefixer]

Eyefixer,

afraid of an argument that you oppose? lol you have to stoop to Dictator Obama like tactics--->"stop feeding the troll" I bet you voted for him........

. You do not know me personally; as a matter of fact, you don't know anyone on this forum. See, no one wants to have a discussion with you on the issues you bring up here. Like I said before, YOU WILL NOT CHANGE ANY MINDS ON THE OPHTHALMOLOGY FORUM. Period. Now I have to go, I have 9 more cataracts to remove today...

 

[Oculomotor]

cool , I am not trying to change any minds.........MD's are set in their ways....YOU KNOW THAT! LMFAO

I have 4 more classes to attend today.....have fun with those cataracts....!!!!!!!!

 

[VA Hopeful Dr]

cool , I am not trying to change any minds.........MD's are set in their ways....YOU KNOW THAT! LMFAO

I have 4 more classes to attend today.....have fun with those cataracts....!!!!!!!!

Then why are you here?

I was enjoying the back and forth between KHE and cme2c when you and your ridiculous font sizes and bolded words (and God help me, your stupid 17 year old girl abbreviations) came and basically took a dump on this thread. Please go away.

 

[Oculomotor]

Temper Temper VA! (did you like that bolding of letters you wuss?) Your last comment was a big brown terd on this thread. By the way tonite I had a beer with a buddy of mine who is an ophthalmologist and guess what? He thinks this forum is ridiculous as I think it is! SURPRISE SURPRISE! He even thinks that the OMD's pumping their chests on here will be sweet as can be with the form letters to OD's "thank you for your patient Dr. So and So O.D." and run their mouths behind closed doors and yes behind the computer screen as well. SDN is a joke and I am on here for amusement. My brother who is ALSO an MD (many of these MD folks in my family) said, "It used to be called Scutworks and it was a ******ed place back then. A bunch of people who were either lying about who they were or obviously not busy enough." So VA you really need to relax. I leave this forum for a month or two at a time and then come back to laugh at it's nonsense.


Can't you understand that? Other than a good argument here or there this is like playing a video game.


I hope you like the bolding---It was for you
And by the way if you are a "medical student" (I'm sure you are) then why are you on here? Is med school that easy that you have sooo much time? I jump on in the 10 minute break between classes with a classmate in tow laughing at what I am typing....

 

[Oculomotor]

Oh Va,


One more thing......Even though I am not Christian, I am sorry that I made Jesus cry!

 

[VA Hopeful Dr]

Temper Temper VA! (did you like that bolding of letters you wuss?) Your last comment was a big brown terd on this thread. By the way tonite I had a beer with a buddy of mine who is an ophthalmologist and guess what? He thinks this forum is ridiculous as I think it is! SURPRISE SURPRISE! He even thinks that the OMD's pumping their chests on here will be sweet as can be with the form letters to OD's "thank you for your patient Dr. So and So O.D." and run their mouths behind closed doors and yes behind the computer screen as well. SDN is a joke and I am on here for amusement. My brother who is ALSO an MD (many of these MD folks in my family) said, "It used to be called Scutworks and it was a ******ed place back then. A bunch of people who were either lying about who they were or obviously not busy enough." So VA you really need to relax. I leave this forum for a month or two at a time and then come back to laugh at it's nonsense.


Can't you understand that? Other than a good argument here or there this is like playing a video game.


I hope you like the bolding---It was for you
And by the way if you are a "medical student" (I'm sure you are) then why are you on here? Is med school that easy that you have sooo much time? I jump on in the 10 minute break between classes with a classmate in tow laughing at what I am typing....

Most specialties talk crap about the others behind their backs, doesn't make ophthalmologists special. As for SDN being a joke, I'm going to disagree with you there. If the threads aren't contentious, like this one, they tend to be pretty informative. See the Help thread in the Young Ophthalmologist subforum.

I'm a 4th year med student who doesn't want to go into a competitive specialty - this year is basically a vacation. Currently I'm on a rotation where I spend 1 hour in the hospital, another hour here doing some paperwork, and that's it. It's glorious.

 

[PBEA]

In skimming this thread I saw a comment that the ophtho (I believe cme2c) feels more comfortable with a PA or NP prescribing oral medication for ocular disease then an OD. I would further conclude that cme2c feels better having a PCP or other non-ophtho MD rxing oral medications for ocular disease. I'd just add my two cents by saying I think the politics of OD vs OMD turf battles are clouding your judgement. There is nary a shred or truth in your comments, and while a PCP et al is certainly more capable at dealing with the host of physical ailments, as compared to an OD, I feel it laughable to compare their ability to diagnose (let alone treat) ANY eye disease with any accuracy, as compared to an OD. I might feel inclined to agree with you, that the OD education leaves something to desired with regard to the application of most oral medications. However, I would just say that the armamentarium of the ave ophtho (oral only) amounts roughly to a bakers dozen, and for the OD it is vanishingly smaller (for which we get considerably more training in treating eye disease then any PA, PCP, etc). As well, I do think there is plenty of safety built into the very conservative approach ODs have to pt care. In short, "to punt or not to punt" based on perfectly obtained pertinent physical findings. This as opposed to the "careful" external observation put forth by the ever empirical PCP approach............give me a break. Their only defense being incidence and prevalence, or put another way, there is no defense. Of course, in the court of law their defense is ironclad, it's called the "standard of care". For the PCP treating an "eye problem", that loosely translates to they don't actually need to know what they are treating or perform any of the confimatory tests required of ophtho's and ODs. Instead they can treat anything that simply appears "minor", without actually knowing that it is. That is one sweet deal!!!, and a hell of a double standard.

If you think you can argue against the OD while turning the cheek with regard to NPs, PCPs, etc, then it is clear that you have ALOT more learning ahead.

batter up?

 

[Oculomotor]

SWING BATTA BATTA SWINGGGGGGGGGGG!!!!!


I just spent 1 year in general pharmacology and a semsester in ocular pharmacology. This semester I started a 2 year sequence of ocular disease/pathology/pharmacuetical management courses. This will be backed up by the experience in clinical rotations for the last two years of OD school......Now granted we are NOT trained to treat systemic disease ONLY ocular disease and the ocular manifestation of systemic disease. And to that end we are well trained and have many safeguards built in. Just as PBEA stated only 8% of the drugs we prescribe are by the Oral systemic delivery route. Some examples of Oral meds prescribed by OD's are

• Acyclovir/Valcyclovir/Famciclovir to treat Ocular Herpes
• Methylprednisolone to treat Ocular Allergies (such as Bilateral Acute Blephrodermatitis)
• Doxycycliine to treat non-infectious lid disease
• Cephalexin for infectious lid diseases
• ......etc............etc........

My point is no family practice MD, or at the lowest common denominator --> PA or NP has any business treating things they cannot properly diagnose. Just because you have an MD doesn't mean you should shove drugs down a patient's throat or order your PA/NP to do the same. OMD"s and OD's can properly diagnose this stuff and properly treat it. The OD's treat the primary ocluar diseases and refer to OMD's for further treatment when it is merited. ..... Just throwing antibiotics empirically at every red eye, lid itch, etc is ridiculous but it happens ALL the time and these folks come in to our clinic wondering why what "the doctor. or the PA supervised by the doctor" gave them did not work.

I am sick and tired of my education being scoffed at by self-riteous pigs (not naming any names.....lol)
Sure cme2c has it all figured out--->with his vast experience and the 2 years of PA school training (1 yr of clinical, 1 year of watered down classes)of his PA sidekicks who cme2c likes to have write "MD supervised prescriptions" for oral meds to treat eye diseses for his patients. What a joke....

 

[cme2c]

In skimming this thread I saw a comment that the ophtho (I believe cme2c) feels more comfortable with a PA or NP prescribing oral medication for ocular disease then an OD. I would further conclude that cme2c feels better having a PCP or other non-ophtho MD rxing oral medications for ocular disease. I'd just add my two cents by saying I think the politics of OD vs OMD turf battles are clouding your judgement. There is nary a shred or truth in your comments, and while a PCP et al is certainly more capable at dealing with the host of physical ailments, as compared to an OD, I feel it laughable to compare their ability to diagnose (let alone treat) ANY eye disease with any accuracy, as compared to an OD. I might feel inclined to agree with you, that the OD education leaves something to desired with regard to the application of most oral medications. However, I would just say that the armamentarium of the ave ophtho (oral only) amounts roughly to a bakers dozen, and for the OD it is vanishingly smaller (for which we get considerably more training in treating eye disease then any PA, PCP, etc). As well, I do think there is plenty of safety built into the very conservative approach ODs have to pt care. In short, "to punt or not to punt" based on perfectly obtained pertinent physical findings. This as opposed to the "careful" external observation put forth by the ever empirical PCP approach............give me a break. Their only defense being incidence and prevalence, or put another way, there is no defense. Of course, in the court of law their defense is ironclad, it's called the "standard of care". For the PCP treating an "eye problem", that loosely translates to they don't actually need to know what they are treating or perform any of the confimatory tests required of ophtho's and ODs. Instead they can treat anything that simply appears "minor", without actually knowing that it is. That is one sweet deal!!!, and a hell of a double standard.

If you think you can argue against the OD while turning the cheek with regard to NPs, PCPs, etc, then it is clear that you have ALOT more learning ahead.

batter up?

You are twisting my words. I absolutely agree that PAs and NPs are not trained for diagnosis of eye problems out of school, but I frequently collaborate with them for patients that need systemic treatment. If I have a patient that needs oral steroids, I call them and we do it together. I make the diagnosis, but they know the patient's systemic disease better than I do and they help monitor the patient for the potentially life-threatening systemic side effects. I then follow the ocular disease and adjust the medications in conjunction with the PCP. I do think that it would be possible to spend a year or two training an NP or PA to do much of what we do in an general eye clinic. Taking care of red eyes, styes, small fbs/abrasions and doing preop physicals would be very reasonable. But, again that would require more training from their baseline. In no way did I say are better trained at diagnosing and treating ocular disease straight out of NP or PA school.

The disconnect here is that people keep harping about "ocular disease" and "within scope". A systemic medication doesn't have any less risk if it's used for "ocular disease" or "within scope." There are medications that have significant risk and no amount of classroom work in the world will prepare you for that. Even ophthalmology residency doesn't prepare one for that. We use them sparingly enough that one would not get adequate training with our 1st and 2nd year of med school classroom work and our 3 years of eye residency alone. It's the 2 years of broad clinic clerkships and the year of intensive internship that gives an ophthalmologist that experience. I absolutely agree with you that most ODs are not a problem. Most I know don't want to prescribe prednisone, diamox, etc but there are those that think "a year of pharm courses" and their OD clerkships give them carte blanche to prescribe anything they heard about in a classroom their first year of OD school.

 

[PBEA]

You are twisting my words. I absolutely agree that PAs and NPs are not trained for diagnosis of eye problems out of school, but I frequently collaborate with them for patients that need systemic treatment. If I have a patient that needs oral steroids, I call them and we do it together. I make the diagnosis, but they know the patient's systemic disease better than I do and they help monitor the patient for the potentially life-threatening systemic side effects. I then follow the ocular disease and adjust the medications in conjunction with the PCP. I do think that it would be possible to spend a year or two training an NP or PA to do much of what we do in an general eye clinic. Taking care of red eyes, styes, small fbs/abrasions and doing preop physicals would be very reasonable. But, again that would require more training from their baseline. In no way did I say are better trained at diagnosing and treating ocular disease straight out of NP or PA school.

The disconnect here is that people keep harping about "ocular disease" and "within scope". A systemic medication doesn't have any less risk if it's used for "ocular disease" or "within scope." There are medications that have significant risk and no amount of classroom work in the world will prepare you for that. Even ophthalmology residency doesn't prepare one for that. We use them sparingly enough that one would not get adequate training with our 1st and 2nd year of med school classroom work and our 3 years of eye residency alone. It's the 2 years of broad clinic clerkships and the year of intensive internship that gives an ophthalmologist that experience. I absolutely agree with you that most ODs are not a problem. Most I know don't want to prescribe prednisone, diamox, etc but there are those that think "a year of pharm courses" and their OD clerkships give them carte blanche to prescribe anything they heard about in a classroom their first year of OD school.

Ok, I think we are in some agreement.

Your last comment about "carte blanche" is in my experience totally untrue (on what basis do you make this accusation?). I would be careful basing judgement on what an OD student has to say about anything (or MD student for that matter), especially on an internet forum. I would rephrase that comment as "very carefully applied without exception, and to the same level of safety as our ophtho counterparts". That is after all, our collective "standard of care".

 

[cme2c]

Ok, I think we are in some agreement.

Your last comment about "carte blanche" is in my experience totally untrue (on what basis do you make this accusation?). I would be careful basing judgement on what an OD student has to say about anything (or MD student for that matter), especially on an internet forum. I would rephrase that comment as "very carefully applied without exception, and to the same level of safety as our ophtho counterparts". That is after all, our collective "standard of care".

My use of "carte blanche" was referring to those like oculomotor that want to have no restrictions on prescribing privileges. My judgement is not solely based on his posts. I do have a couple ODs in my territory who act like he posts. They think they know what they are doing, but just don't get it. They miss the pseudotumor caused by their doxycycline, put people in the hospital with their steroids, and overtreat their styes with augmentin and give people colitis. My experience is biased based on my type of practice. Our groups covers most of the hospitals in town. So any of those patients that ends up in the hospital, we get a consult. It happens more often than you think.

Another issue that causes problems is that I don't see ODs communicating as well with the PCPs as EyeMDs. For me it's easy, I know alot of my PCP referrers personally because that's where the majority of my patients come from, many of which I knew from med school training. So when I need help with a patient it's easy for me to pick up the phone and call the PCP that I know. But, I can see why that may be more difficult for an OD. They don't have the same connections. They may also worry that the PCP will then refer the patient to an EyeMD. So I can understand some of that hesitance dealing with the "boys club." I get a couple referrals a month from a PCP who wants their patient to see me because they had no idea what was going on due to poor communication from their O.D. The O.D. was taking great care of them, just not communicating. My previous practice in rural America was a little different than my urban practice now. The PCPs and ODs did seem to work better together because there weren't as many EyeMDs. It was also easier in a small town for ODs and PCPs to know each other,etc.

I do not deny the there are plenty of bad apple EyeMDs either. I see a fair amount of clear lens "cataract" surgery, lots of inappropriate LASIK. But that is an ethical issue not a training issue. I absolutely wish there was a good way to get a "bad" physician's privileges limited easily but it is very difficult. That's why IMO that when there is any question about training that it is better to limit privileges upfront rather than go through the bureaucracy to limit the bad ones.