Would you hire an Ophthalmic Physician Assistant?

[KHE]

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.

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.

The fact that you have two reckless ODs in your area who overtreat styes or who don't consult with PCPs when using short term steroids is not any reason to throw out the baby with the bathwater anymore than banning LASIK is because some surgeons in LASIK mills do it on everyone and their dog. Pseudotumor is not common and it's not something that's easily missed, at least by eye care people. (it shouldn't be anyways) Do dentists cause a lot of colitis or pseudotumor with their antibiotics?

You're making some legitimate points. But I think that you're coming at it from the viewpoint that traditional allopathic medical education is the only possible path to enlightenment. That's not the case. Other professions (the dentists and the podiatrists are the ones usually mentioned) are doing far more invasive procedures and using all kinds of systemic medications and yet they have "4 years of school."

If you want to make the argument that optometry school doesn't adequately prepare optometrists to do some things that they are technically licensed to do, in some cases you may be right. I would however point out that in those cases, optometrists almost universally recognize that. ODs as a group are incredibly conservative, in many cases to a fault. But I also think that with adjustments to optometric curriculum that those issues can be addressed easily within the confines of the traditional 4 year program.

Nevermind oculomotor. He's a 2nd year gasbag all full of piss and vinegar. Where I grew up, we called people like that s*it disturbers. A s*it disturber is someone who's constantly making snide comments or making little zingers just to try to stir up the pot.

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[DOCTORSAIB]

Nevermind oculomotor. He's a 2nd year gasbag all full of piss and vinegar.

 

[MAYOphtho]

I think the big mistake EVERYONE is forgetting here is that both providers do a LOT of the things the other doesnt want to do...

Can I prescribe RGP contact lenses (or other CL for that matter)? Of course I can, but do I want to? Definitely not...I'd rather be in the operating room...that goes without saying...If I didn't have Optom doing this service for us (for the majority of the time), I would definitely have to change the scope of my practice...

I would imagine the reverse is true. Most Optoms probably did not have an interest in operating and thus went to their OD school. Do some subsequently wish they could operate? I'm sure they might...but in the end they really are the primary care doctor that can often times manage most things that come through their doors. Are some of them awful? Yes, but I've also seen bad OMDs as well...

Nobody is perfect and there will be good and bad doctors across the board...

so I think each side should just take a step back and be relieved at the service the other side provides.

ODs can work regular hours without worrying about open globes (etc) coming in at 1:15am (and going to the OR at 2:40 til whenever), be primary eye care physicians, and make a stable/good income. OMDs can enjoy surgical privilege, a reasonable MD working schedule, and medically/surgically treat a vast array of difficult pathology.

I think the original spirit of all this is lost when people start fighting and let tempers fly...when all it takes is one **** starter (who openly admitted earlier he/she does such while in class because his/her super cool friends egg him/her on).

So can we finally just let this stupid thread die? The point of the thread isnt even being discussed anymore.

 

[cme2c]

The fact that you have two reckless ODs in your area who overtreat styes or who don't consult with PCPs when using short term steroids is not any reason to throw out the baby with the bathwater anymore than banning LASIK is because some surgeons in LASIK mills do it on everyone and their dog. Pseudotumor is not common and it's not something that's easily missed, at least by eye care people. (it shouldn't be anyways) Do dentists cause a lot of colitis or pseudotumor with their antibiotics?

You're making some legitimate points. But I think that you're coming at it from the viewpoint that traditional allopathic medical education is the only possible path to enlightenment. That's not the case. Other professions (the dentists and the podiatrists are the ones usually mentioned) are doing far more invasive procedures and using all kinds of systemic medications and yet they have "4 years of school."

If you want to make the argument that optometry school doesn't adequately prepare optometrists to do some things that they are technically licensed to do, in some cases you may be right. I would however point out that in those cases, optometrists almost universally recognize that. ODs as a group are incredibly conservative, in many cases to a fault. But I also think that with adjustments to optometric curriculum that those issues can be addressed easily within the confines of the traditional 4 year program.

Nevermind oculomotor. He's a 2nd year gasbag all full of piss and vinegar. Where I grew up, we called people like that s*it disturbers. A s*it disturber is someone who's constantly making snide comments or making little zingers just to try to stir up the pot.

As I stated before, I have problems with dentists' prescribing privileges too. But, two wrongs don't make a right. While I agree that ODs "almost universally" recognize that they are not prepared for some things, it's still "almost". Personally, I don't think a small curriculum change would change my mind personally. There would have to be signficant clinical clerkships to get the experience. These would need to be in areas like Internal Medicine, FP, ER, etc. I feel I can speak for most MDs when I say that the 1st 2 years of medical school I learned 10% of what I did the next two years in my clinical clerkships. That's not to say those 1st 2 years are useless, they provided the knowledge base that was then able to explode with the hands-on experience.

 

[Oculomotor]

I take it as a compliment KHE.....Just keep in mind just like said earlier I am one of those pitbulls who "in the real world" wants on their side when there is a legislative battle or legal battle. The difference is (I must educate you because we are about the same age) that in the real world my responses are tempered and professional----> they have to be. On this forum it is about having fun and letting go of the fascade and windowdressing public professionalism is trapped in. I think before you insult a fellow (future optometrist) you should actually know me in the real world! lol


Look in all seriousness Optometry and Ophthalmology are co-habitating in the real world. They are interdependent (Ophthalmology needs Optometry's $$patients$$ while Optometry needs to send their patients to Ophthalmolgy when the care needed is out of an OD's scope). It actually works very well in most circumstances....

 

[Oculomotor]

"I think the big mistake EVERYONE is forgetting here is that both providers do a LOT of the things the other doesnt want to do...

Can I prescribe RGP contact lenses (or other CL for that matter)? Of course I can, but do I want to? Definitely not...I'd rather be in the operating room...that goes without saying...If I didn't have Optom doing this service for us (for the majority of the time), I would definitely have to change the scope of my practice...

I would imagine the reverse is true. Most Optoms probably did not have an interest in operating and thus went to their OD school. Do some subsequently wish they could operate? I'm sure they might...but in the end they really are the primary care doctor that can often times manage most things that come through their doors. Are some of them awful? Yes, but I've also seen bad OMDs as well...

Nobody is perfect and there will be good and bad doctors across the board...

so I think each side should just take a step back and be relieved at the service the other side provides.

ODs can work regular hours without worrying about open globes (etc) coming in at 1:15am (and going to the OR at 2:40 til whenever), be primary eye care physicians, and make a stable/good income. OMDs can enjoy surgical privilege, a reasonable MD working schedule, and medically/surgically treat a vast array of difficult pathology.

I think the original spirit of all this is lost when people start fighting and let tempers fly...when all it takes is one **** starter (who openly admitted earlier he/she does such while in class because his/her super cool friends egg him/her on).

So can we finally just let this stupid thread die? The point of the thread isnt even being discussed anymore."


You made the best post ever on a thread like this. At 30 something and beginning my 3rd year of school, I agree with you 100%!!!.

Thank you for making a post that is fair and respectful to both optometry and ophthalmology.

 

[Oculomotor]

So cme2c,

What if (hypothetically) MD's were restricted by law to practicing ONLY within the scope of their residency training? I think that is fair and protects the public. Case in point, my PharmD friend refused to fill a prescription for birth control from a Plastic Surgeon (for one of his friends) on the grounds that it is an inappropriate Rx for his area of practice. He yelled and screamed at her on the phone and then found a pharmacist who filled it. Do you think it is ok for a DO family practice doctor around the corner from my house who does liposuction (no surgical residency)? Or how about the family doctor down the street who is advertising (latisse---bimatoprost) for cosmetic enhancement of eyelashes. I am sure she has a lot of experience prescribing bimatoprost ophthalmic solution to lower IOP. and understands the side effects (suntan iris, etc...). Oh and the 5 million "pain clinics" in Ft Lauderdale---> I am sure every one of those is in the best interest of patients. And finally the MD (I can send you a link) that I found out in my area that is doing dental work on some of his patients----> SCARY.

My point is that there are people in EVERY profession that step out of line but the "carte blanch" medical license gives MD's access to more invasive things and therefore more risk to an unsuspecting public.

You make some good points but I have seen MANY MANY MANY more people hurt by poor decisions by MD's than any other profession.

I do agree with you on one thing, I would like to see optometry school include a 6 month to one year rotation in internal medicine, family medicine, and pathology. I believe it would be very useful to back up the didactic training more.

 

[KHE]

I take it as a compliment KHE.....Just keep in mind just like said earlier I am one of those pitbulls who "in the real world" wants on their side when there is a legislative battle or legal battle. The difference is (I must educate you because we are about the same age) that in the real world my responses are tempered and professional----> they have to be. On this forum it is about having fun and letting go of the fascade and windowdressing public professionalism is trapped in. I think before you insult a fellow (future optometrist) you should actually know me in the real world! lol

The very definition of a s*hit disturber.

 

[Oculomotor]

KHE, Actually I am not trying to start anything.........seriously! I RESPOND to things on here..........


You fit the definition of the "The Appeaser"........I am sorry but I am not that soft.


Goodbye

 

[cme2c]

So cme2c,

What if (hypothetically) MD's were restricted by law to practicing ONLY within the scope of their residency training? I think that is fair and protects the public. Case in point, my PharmD friend refused to fill a prescription for birth control from a Plastic Surgeon (for one of his friends) on the grounds that it is an inappropriate Rx for his area of practice. He yelled and screamed at her on the phone and then found a pharmacist who filled it. Do you think it is ok for a DO family practice doctor around the corner from my house who does liposuction (no surgical residency)? Or how about the family doctor down the street who is advertising (latisse---bimatoprost) for cosmetic enhancement of eyelashes. I am sure she has a lot of experience prescribing bimatoprost ophthalmic solution to lower IOP. and understands the side effects (suntan iris, etc...). Oh and the 5 million "pain clinics" in Ft Lauderdale---> I am sure every one of those is in the best interest of patients. And finally the MD (I can send you a link) that I found out in my area that is doing dental work on some of his patients----> SCARY.

My point is that there are people in EVERY profession that step out of line but the "carte blanch" medical license gives MD's access to more invasive things and therefore more risk to an unsuspecting public.

You make some good points but I have seen MANY MANY MANY more people hurt by poor decisions by MD's than any other profession.

I do agree with you on one thing, I would like to see optometry school include a 6 month to one year rotation in internal medicine, family medicine, and pathology. I believe it would be very useful to back up the didactic training more.

I absolutely agree with you. There should be more oversight on who is practicing what with an MD license. While we do have board certifications wihtin each area, they are not perfect. I said earlier in the thread:

"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"

The birth control example doesn't fly with me because we get required training on that in medical school. Internships, even surgical ones will have exposure to them and other hormone replacement therapy.

MDs doing dental work, absolutely agree with you, unless they were a dentist first.

Surgical procedures are hard, because there are so many new surgical procedures that come along. You can't get residency training in everything. But, you can get training in basic surgical principles that can be used when newer techniques come along. FP residencies do have surgical rotations, and FPs are frequently doing C-sections, so with the proper experience they could be competent to do liposuction. But they should have to prove competence. Hospitals and surgery centers would require that proof, but agreed docs can just open up their own center to do it if they wanted.

Pain clinics should be an individual thing. We get plenty of training prescribing pain meds during med school and internship. I had done over 50 spinal taps by the time I was done with internship, so I felt competent doing pain injections. Someone who did a full blown 3 year IM residency would be likely be competent as well.

I think Latisse being marketing to non-eye docs is ridiculous. I have told my Allergan rep and basically have quit prescribing their products as a result unless absolutely necessary. While medical schools all have required lectures on the eye, there are very few that have required ophthalmology rotations. As I have stated before, I am a firm believer in the clerkships and internship education. They already limit Latisse to being sold in offices only, but they should have just limited it to eye doc offices or required extensive training before offering letting someone sell it.

 

[Meibomian SxN]

...The birth control example doesn't fly with me because we get required training on that in medical school. Internships, even surgical ones will have exposure to them and other hormone replacement therapy.

MDs doing dental work, absolutely agree with you, unless they were a dentist first.

Pain clinics should be an individual thing. We get plenty of training prescribing pain meds during med school and internship. I had done over 50 spinal taps by the time I was done with internship, so I felt competent doing pain injections. Someone who did a full blown 3 year IM residency would be likely be competent as well.

None of your responses "fly" with me. I know for a fact MDs are not extensively trained in pain management, hence that's why its an actual IM fellowship.

And about BCPs, even nurses can Rx them. The problem with the Plastic surgeon Rx'ing them is that will they do the blood work and follow-up care on the Px taking them? Most likely not, so that is why it is given to a primary care physician to monitor for ADVERSE EFFECTS.

In the optometry curriculum we were given good enough training on interpreting CT/MRI/Cranial angiography (even EKGs),yet I hardly go ordering them without a Radiologist consult. At our optometry school the Neuro-Oph professor was an OD who taught the Neuro-Oph FELLOWS at Scheie Eye (UPenn), so many of us were more than trained to interpret them for self. Yet rarely we do wothout consulting.

So please state the truth next time instead of fictional classroom/wetlab confidence...

 

[cme2c]

None of your responses "fly" with me. I know for a fact MDs are not extensively trained in pain management, hence that's why its an actual IM fellowship.

And about BCPs, even nurses can Rx them. The problem with the Plastic surgeon Rx'ing them is that will they do the blood work and follow-up care on the Px taking them? Most likely not, so that is why it is given to a primary care physician to monitor for ADVERSE EFFECTS.

In the optometry curriculum we were given good enough training on interpreting CT/MRI/Cranial angiography (even EKGs),yet I hardly go ordering them without a Radiologist consult. At our optometry school the Neuro-Oph professor was an OD who taught the Neuro-Oph FELLOWS at Scheie Eye (UPenn), so many of us were more than trained to interpret them for self. Yet rarely we do wothout consulting.

So please state the truth next time instead of fictional classroom/wetlab confidence...

Ok first. Pain fellowships are typically after Anesthesia residencies, not IM. My reference to IM was that an IM trained person could also do Pain management because many of the skills were learned in the residency. My IM internship I had extensive experience writing pain scripts and doing LPs. But it is very unusual to do a pain fellowship after IM.

Second, what routine blood workup for BCPs are you referring to? No, "nurses" cannot Rx them. Nurse practitioners can, but not a "nurse." There is a difference. That is what scares people.

Not sure where the radiology babble comes from, it's a quite different situation from the other examples. I can't think of any Eye MDs who get scans without a radiology read. Frankly, I don't know of anywhere I can get one without a radiologist reading it. But, evidently you can get scans without a radiology "consult". Yeah right. I highly doubt that because any hospital or facility that does scans will not want the liability if something is missed. Incidentalomas happen all the time, so that Orbit CT you order may show a tonsillar tumor and you weren't train to look there. That's why radiologists read scans.

 

[Meibomian SxN]

First for your information, pain fellowships can be after either. My sister in law is Board Certified in Pain Medicine and did NOT do anesthesia, she was IM. Most interns training varies so I'm sure not doing LPs now...

I thought you were trained to Rx BCPs? And your asking what blood work? Scary...also a nurse practitioner is a nurse with further training, but that is what I meant.

And when I say without a consult, it means I get the original scan and read it myself. Good day.

Ok first. Pain fellowships are typically after Anesthesia residencies, not IM. My reference to IM was that an IM trained person could also do Pain management because many of the skills were learned in the residency. My IM internship I had extensive experience writing pain scripts and doing LPs. But it is very unusual to do a pain fellowship after IM.

Second, what routine blood workup for BCPs are you referring to? No, "nurses" cannot Rx them. Nurse practitioners can, but not a "nurse." There is a difference. That is what scares people.

Not sure where the radiology babble comes from, it's a quite different situation from the other examples. I can't think of any Eye MDs who get scans without a radiology read. Frankly, I don't know of anywhere I can get one without a radiologist reading it. But, evidently you can get scans without a radiology "consult". Yeah right. I highly doubt that because any hospital or facility that does scans will not want the liability if something is missed. Incidentalomas happen all the time, so that Orbit CT you order may show a tonsillar tumor and you weren't train to look there. That's why radiologists read scans.

 

[cme2c]

First for your information, pain fellowships can be after either. My sister in law is Board Certified in Pain Medicine and did NOT do anesthesia, she was IM. Most interns training varies so I'm sure not doing LPs now...

I thought you were trained to Rx BCPs? And your asking what blood work? Scary...also a nurse practitioner is a nurse with further training, but that is what I meant.

And when I say without a consult, it means I get the original scan and read it myself. Good day.

Pain fellowships can be after either, but the VAST majority are after anesthesia. I am trained to Rx BCPs, my question was rhetorical, there is no routine bloodwork necessary for BCPs. Your misuse of the word consult is a sign of not even knowing the terminology of the medical system, which the THE PROBLEM!!!

 

[meister]

These silly turf war battles are just a symptom of a larger problem. If we were all being honest with ourselves we would admit that there really is no reason for dental school, or optometry school, or pharmacy school, or CRNA school, or NP school, or PA school, or undergraduate pre-medical degrees. The AMA severely restricted the number of medical schools and as a result these other professional schools popped up out of nowhere to fill the gap. Dentists, pharmacists, and podiatrists just have specially carved untouchable niches, which really are nonsensical.

If we were starting the system from scratch it would just be a 4 year general medical undergraduate degree with post-graduate specialty training to do whatever. Rather than try to achieve those ends, we wind up using the law to protect scopes of practice and have weird situations like we have now. It's all pretty dumb, really.

Oh well. Just my opinion.

 

[PBEA]

These silly turf war battles are just a symptom of a larger problem. If we were all being honest with ourselves we would admit that there really is no reason for dental school, or optometry school, or pharmacy school, or CRNA school, or NP school, or PA school, or undergraduate pre-medical degrees. The AMA severely restricted the number of medical schools and as a result these other professional schools popped up out of nowhere to fill the gap. Dentists, pharmacists, and podiatrists just have specially carved untouchable niches, which really are nonsensical.

If we were starting the system from scratch it would just be a 4 year general medical undergraduate degree with post-graduate specialty training to do whatever. Rather than try to achieve those ends, we wind up using the law to protect scopes of practice and have weird situations like we have now. It's all pretty dumb, really.

Oh well. Just my opinion.

I completely agree with this, and would willingly change the system to support this. If I could

 

[jefguth]

The AMA severely restricted the number of medical schools and as a result these other professional schools popped up out of nowhere to fill the gap. Dentists, pharmacists, and podiatrists just have specially carved untouchable niches, which really are nonsensical.

Ummm, I think all of those professions were well established long long before the AMA was even a thought.

As for podiatrists, their specialty is hardly an untouchable niche, they're always engaged in the same turf battle with orthopedics just as optometry is with ophthalmology.