This was posted in the optometry forum.

http://forums.studentdoctor.net/showthread.php?t=123623
http://www.revoptom.com/drugguide.asp?show=view&articleid=2

I find it rather disturbing when an article "teaches" optometrists how to prescribe medications like prednisone without much emphasis on the systemic side effects. :eek:

"Optometric physicians and their patients are enjoying the huge benefits of topically applied medications. Now it's time to fully embrace a different route of administration: the orally administered medicines. So that we can put this subset of drugs in perspective, realize that the internist must master hundreds of medicines; we only need to master a baker's dozen (give or take) to treat the vast majority of ophthalmic diseases."

The term optometric physicians appears again. Way to blur the lines even more! :rolleyes:

This was posted in the optometry forum.

http://forums.studentdoctor.net/showthread.php?t=123623
http://www.revoptom.com/drugguide.asp?show=view&articleid=2

I find it rather disturbing when an article "teaches" optometrists how to prescribe medications like prednisone without much emphasis on the systemic side effects. :eek:....

...The term optometric physicians appears again. Way to blur the lines even more! :rolleyes:

Dr. Doan,

I believe that a characterization of this article and the guide might have been appropriate had this guide been the basis of a course much like a textbook. In reality, this article and the "guide" is what it is, simply a "pocket guide" that serves the same purpose as any other number of "pocket guides" one finds in healthcare. As such, it would be a disservice to the "professions" if you were to continue to characterize this guide as a textbook or as a foundation for a pharmacology course.

In addition, you're correct in optometry's unfortunate terminology of "optometric physician" I believe such use is defined in state law and only in a few states.

Richard_Hom

Dr. Doan,

I believe that a characterization of this article and the guide might have been appropriate had this guide been the basis of a course much like a textbook. In reality, this article and the "guide" is what it is, simply a "pocket guide" that serves the same purpose as any other number of "pocket guides" one finds in healthcare. As such, it would be a disservice to the "professions" if you were to continue to characterize this guide as a textbook or as a foundation for a pharmacology course.

In addition, you're correct in optometry's unfortunate terminology of "optometric physician" I believe such use is defined in state law and only in a few states.

Richard_Hom

Dr. Hom,

Good points. However, even my "pocket guide" on my palm (Lexidrugs) lists side effects and contraindications.

If an article is written to discuss how to prescribe systemic medications, then some time should be spent to discuss the serious manifestations of a drug like prednisone. The article spends time listing contraindications with CAI, but treats prednisone like a "magic pill" for inflammation. I doubt few people remember all the side effects of steroids from a pharmacy class taken 2, 5, or 10 years previous.

Dr. Doan,
Who is the hottie in the picture? I think she is very pretty!!


Dr. Hom,

Good points. However, even my "pocket guide" on my palm (Lexidrugs) lists side effects and contraindications.

If an article is written to discuss how to prescribe systemic medications, then some time should be spent to discuss the serious manifestations of a drug like prednisone. The article spends time listing contraindications with CAI, but treats prednisone like a "magic pill" for inflammation. I doubt few people remember all the side effects of steroids from a pharmacy class taken 2, 5, or 10 years previous.

Dr. Hom,

Good points. However, even my "pocket guide" on my palm (Lexidrugs) lists side effects and contraindications.."

Dr. Doan,

Likewise good points.

One thing to remember. Let us criticize the authors rather than the profession as a whole. As you know the vehicle or venue for this pocket guide is an insert within a magazine and as such is constrained by editorial guidelines. In addition, pocket guides come in all sizes and shapes. This is a "throw away"and "free" pocket guide.

I'm sure that most practicing optometrists who prescribe frequently will have the hospital or medical plan formulary in one hand, Merck Manual or Merck Index in the other (or less so the PDR) and still in another hand the Wills Eye Manual.

As you may know, there many "eye" books, some will have significant value and others will have less so. We have reviews in our journals to guide the reader on their purchase or reading decisions. Your comments would have been more relevant, appropriate and less inflammatory had you reviewed the material rather than "demonizing" the profession from this singular publication.

I say this because in numerous other posts, you have sought the "reasonable" optometrist to offer their opinions on the possible expansion into surgery. Highly charged and one-sided comments and views may distract potentially "fence sitters".

In conclusion, I feel that many of your comments are about optometry are well-thought out and deserves attention. To ensure that may reach a wider audience (optometry include, I'm assuming that is your purpose), I'm hopeful that you will apply the journalist's paradigm of occasional objectivity.

Yours truly,
RIchard_Hom

we took pharmacology with the dental students at uabso , in addition we took 2 other pharm classes, more specific to ocular pharmacology...we were absolutely taught about the systemic side effects and interactions of oral medications!....dr. doan, you do realize that we are taught VERY similer basic science courses compared to the medical students (same professors and books) at uab....in addition we take some classes physically with the md students...(like neuroscience!)...our first two years of classwork, concerning general knowledge about the body, are not a whole lot different from the md student's....we are very well competent to serve a primary eye care position....you know we had this argument in the 80's when we recieved the right to prescribe orals, and opthal. was defeated.....you really need to stop trying to find isolated (not representing the majority) articles to support your anti-optometry position...our healthcare system is more efficient with primary care gatekeepers (like optometry)....it seems to me you are either bitter because we are invading what has been opthal. turf, you guys aren't making as much as you used to, or your ego can't stand the fact another person will be recognized as an eye doctor that didn't go the md route....if you look back in history the osteo. docs had to go through this type of absurd argument.....from reading your posts you seem like a very insecure person?...even though you usually respond to criticism professionally, you just don't seem to get it...or you can't let yourself accept it..you keep talking about the difference b/t od's and omd's....why don't you just relax..we are competent and we can prescribe oral medications and there is a damn good chance we are going to be these procedures your calling surgery in the next 5-10 years (chalazion removal, lasik, yag, alt).. ..as for the optometrists who want to do more invasive procedures I don't agree with them....I wonder how this whole od vs. md thing is going to affect your health over your life time?....you don't seem to welcome change very well or accept it in a positive way.....this whole trend for od's is for better care for the patient's, not a better position for the omd's......now you go ahead and post your lame rebuttal....if anything you should apologize for your inappropriate comments!....and your disrespect for the optometry profession.....I'll go ahead and apologize for the od's in my profession who are trying to do real surgeries...they are wrong....let us all see if you are capable of recognizing that you are wrong in your above thoughts and posts...your criticizing a profession you only know on the surface....why don't you learn exactly what our training is before you open up your mouth again!

I am aware of your training. I'm criticizing the article more than your profession. I do apologize if my post offends you Marley.

However, because you bring it up, I'll elaborate. I think it requires more experience than a few pharmacy courses to prescribe systemic medications like prednisone. Medical doctors go through more than pharmacology courses to learn how to prescribe. Some even go through 7 years of residency and fellowship (e.g., cardiology) to learn how to prescribe medications. As an ophthalmologist, I know enough to stay away from serious systemic medications (e.g. insulin) and defer management to the patient's primary care physician. For medications like prednisone and other immunosuppressives, ophthalmologists will often co-manage with an internist.

My posts have nothing to do with my ego. I don't care about money either because I'll either be a military physician or academic. Whether or not optometry gains more privileges, I am certain I will be a competent physician and financially secure. Good physicians will always make money in this society. I am more fearful about laws that suddenly grant non-physicians, e.g. optometry, psychologists, NP, ect..., full medical privileges without the necessary training. This is about protecting patients, and this is a cause worth fighting for.

I respect the ODs I work with. They've all completed fellowships and are extremely competent. If you all want to have full prescription rights and deal with dangerous systemic medications and eye drops, then perhaps optometry should require all their graduates to complete a one-year fellowship. Less than 15% of optometrists are F.A.A.O., which is rather pathetic. No physician graduates from medical school and receives prescription rights without first completing at least a one-year internship.

please, don't act like you don't know what you are doing,...the article that you are making generalizations about is representing optometry,...don't you know we can all see what you are doing, and those who believe you are just as desperate as you are......o.k. dr. doan I know this is going to be hard for you to hear, but guess what, many of the drugs to treat primary eye care problems can be treated without doing a one year residency..I know this is different than what you have been told or experienced so try and take a deep breathe.....our four year program does prepare us to prescribe oral medicine for primary eye care problems...and of course you must be able to identify what is out of your league and what is not, or what is very serious and what is not....thanks for elaborating....guess what, od's will also often co-manage with an internist or pcp when treating eye problems with oral meds,...I'm fully aware some physcians do a 7 residency or fellowship to prescribe oral meds. (of course, a freaking cardiologist prescribes more serious meds!)......the fact that you are interested in academia makes perfect since to me, (academia is one gigantic circle jerk, perhaps you will fit in!...just from reading your fabricated comments I think you will..people like you know they are empowered by their knowledge and don't want to share it or they act like it is unattainable (i.e. refuse to allow od's to attend aao meetings etc. or give the empression you must be a genious to prescribe tobradex)..if you really wanted the people of america to be better off, you would try and educate as many people as possible!..I love to hear professors from all different areas of medicine boast about the miraculous knowledge they have and how ingenious they must be to treat disease....well that may very well be true for some cases (cardiology).....but for the most part, treating the common "primary care" diseases of the eye is not a miraculous procedure...) you are a little out of touch with the real world....there is a large group of people today that already know what their dr. is going to do for them before they get to the office....the internet is a wonderful resource...the drugs and treatments I'm referring to are extremely safe!....the monopoly md's have on health care is unconstitutional......the beauty of the optometrist is that he/she can treat the primary care problems or screen for and identify (diagnose) the major problems and take the appropriate steps, .....are you aware of the seven deadly sins?....think about vanity and then think about yourself....you need to back the hell up, check your ego.....and quite being naive about your postion on optometry, it is obvious....do you think there are idiots reading this page, or intelligent people, OR just freaking relax...you are the expert in eye care...it's o.k. nobody is going to take that from you, when I have my proliferative diabetic pt. in the chair, you (an omd)...will be the person I glorify and educate the pt. on your expertise....I must sleep know, I can't wait to here you comments though...........not

You can attack me all you want personally, but your rhetoric is rather immature and unsupported.

Perhaps "you are a little out of touch with the real world" because patients do not "already know what their dr. is going to do for them before they get to the office". Most don't even know the difference between optometry and ophthalmology. Many will print material from the internet, but they have no clue what it means. I spend time everyday explaining the difference between the two fields. Many patients think their optometrists perform "surgeries" when in fact it's co-managing cataract and LASIK patients.

Your cavalier attitude about medications supports what I claim about optometry. Some of the drops and pills you prescribe will blind and kill people. These are NOT "extremely safe" medications. Indeed, when you prescribe something wrong, I am sure there is a physician who will cover your back and care for the patient. No malpractice suit will be charged. No report will ever be made. Why? Because ophthalmologists are afraid their referral base with disappear.

For instance, prescribe timolol or cosopt drops in a patient with asthma, COPD, or heart failure and you may kill them. Prescribe prednisone for pseudotumor in a diabetic with mucormycosis or a patient with orbital cellulitis and you may kill them. Prescribing prednisolone drops when you think it's "iritis" when it's endophthalmitis will blind the patient in 24 hours.

Let's look at how these medications are "extremely safe" by considering these true cases:

Case #1: Last week, a patient came in with "iritis" and increased IOP of 40. The patient was treated by their optometrist with Q1H prednisolone drops and cosopt for 2 weeks without improvement. The patient comes in for a second opinion, and he/she had "iritis" of only red blood cells. In fact, there was a small hyphema, and florid iris neovascularization of the iris from his/her diabetes. Unfortunately, there was no view to the back so PRP couldn't have been delivered. In this case, delay of treatment (PRP) because the patient was being treated for "iritis" may lead to the patient losing his/her eye. Why wasn't the patient referred sooner? Because the OD thought he/she was treating the "iritis".

Case #2: A patient was co-managed and then consulted for increased IOP after cataract extraction. The optometrist was "burping" the cataract wound during the post-operative care (for the whole week) and pouring anti-glaucoma medications on the eye to reduce the pressure without luck. He/she thought that the medications were "treating" the problem. Unfortunately, the "burping" of the cataract wound was the problem because the patient developed a suprachoroidal hemorrhage.

Case #3: A normal tension glaucoma patient was consulted for advanced glaucoma managed only by drops. A GVF demonstrated that the patient had a 20 degree central field left OU. Surgery was needed years previously, and delay of surgery resulted in severe visual loss. Again, prescription drops provided a false sense of security that "treatment" was delivered.

Case #4: A patient had an industrial accident with a sharp piece of metal. The patient felt some "jelly-like material" on his/her cheek and complained of floaters. The vision was 20/20 still. An optometrist saw the conjunctival laceration but missed the 0.5 mm scleral laceration and the vitreous that plugged the hole. The floaters were dismissed as a "migraine phenomenon resulting from trauma". The "jelly-like material" was dismissed as tears or mucous from the eye. The optometrist prescribed Vigamox for the conjunctival laceration and sent the patient home. Over the week, the patient then developed more floaters and decreased vision to 20/60 with an increased anterior chamber reaction. On day #5, steroid was added for "traumatic iritis". The patient dropped from 20/60 vision to hand motions vision in less than 12 hours. The patient developed traumatic endophthalmitis.

I see two problems with the use of drops here. First, the use of Vigamox initially provided the practitioner the belief that he/she was doing something for the patient, when in fact, the patient needed primary closure of the trauma wound. Second, the use of steroids was like pouring gas on a fire. Thus, to accept your argument that our arsenal of medications are ""extremely safe" is similar to saying that guns are available every where and are "safe" to use. Medications are only safe when used properly, so please stop your banter about how primary eye care is so safe and simple.

White arrow points to vitreous and gray arrow points to scleral laceration from a penetrating globe injury in Case #4

http://home.mchsi.com/~sdn_eyeforum/trauma_05232004.jpg

Marley, these examples are of "common "primary care" diseases of the eye". I will agree with you, however, that treating these diseases does not require a "miraculous procedure" if the caregiver knows what they are doing and respects the medications they are prescribing.

This is the art of medicine that you clearly dismiss and have little regard for when you use terms like "extremely safe", "common primary care diseases", and "not a miraculous procedure". Unfortunately, common primary care diseases will blind and kill people too.

First, I really do want to apologize if you think I am attacking you personally, you obviously are a smart man and a good citizen of your community, I respect any person in our military, but somebody needs to keep you in check. The cases that you illustrate above are worthy of mention, but you see we are taught cases and scenario's like this, no **** people can go blind from wrongful use of these drugs!.......that is why we have four years of training..your reviewing some very similar situations we were taught about for od's and omd's, ..you can find isolated cases all day long about the improper handling of certain situations in eye care,...there are thousands of them....the fact is...there are good and bad od's and omd's....the public must and will recognize this....for some situations, second opinions are a must these days...and patient's really must be informed....I'm not sure were you are from, but this is America....our healthcare system and our culture are different, I know there is a large group of people that come to you with no clue, me too....but there is also a large group of people that are educated and can research what problems they are having before they go and see the doctor...primary care providers must screen for potentially dangerous situations and take the appropriate steps...I love to argue with you, and hear you boast about the "art of medicine"..I know there is some skill in it....and that there are primary eye care diseases out there that can blind and kill people...duh.....thank you "Daniel Son" ..when you say it like that, it sounds so untouchable....you know I could argue like yourself in a more "mature" manner....but to me, and I am sure many others, you sound pompous...I am only speaking frankly...of course, my god!...we are trained to know what we are doing and respect the medications we prescribe....I don't dismiss the wonderfull things we do for people when treating primary care problems of the visual system....I simply believe these primary care problems can be treated by an optometrist in this day and age, and there is absolutely no need for you to carry on about your expertise..........keep talking if you want, but you are only loosing face.....the best thing you can do at this point is agree with me, and move on....really, isn't your time more valuable?...

I'm not sure were you are from, but this is America....our healthcare system and our culture are different...
:laugh:

This statement illustrates your ignorance. Bigot comments like the one above gains little support from an intelligent crowd. If one can't support an argument, then the race card will be used. Good job, you convinced me that you are a bigot.

Because I am Asian you assume I am from another country? I grew up in the U.S., attended grade school, college, and medical school in the U.S.

Try picking one idea and stick with it. First you state medications are "extremely safe", and now you claim we must be careful in how we prescribe them?! :rolleyes:

the drugs and treatments I'm referring to are extremely safe!....


no **** people can go blind from wrongful use of these drugs!.......
I know there is some skill in it....and that there are primary eye care diseases out there that can blind and kill people...duh.....

Marley, if you want such a wide scope of practice, why didn't you go to medical school and become an ophthalmologist?

people like you know they are empowered by their knowledge and don't want to share it or they act like it is unattainable (i.e. refuse to allow od's to attend aao meetings etc. or give the empression you must be a genious to prescribe tobradex

Funny. Just a couple weeks ago an OD referred a patient to me that he had kept on Tobradex for a year for his blepharitis. He had pressures of 28 and 30 and a brand-new disc hemorrhage. No, you don't have to be a genius. You just have to be properly trained.

marley, you are the most ignorant sounding person i've ever seen post on this board. i realize that you are new, but insulting andrew in the way you just did is not acceptable.

it's people like you that make me hate your field. you are unprofessional, rude, and give you field a very bad image. i respect most optometrists (at least the ones that realize that they are optometrists, not ophthalmologists). you seem like you want to be one of those cavalier optometrists.

realize your boundaries and limitations for the well being of your patients. your clinical pharmacology courses are not enough to be competent at prescribing medication. all MD'd spend 2 years rotating through the various medical specialties, and another year as a medical or surgical resident. these three years of hands on medicine, plus three more years of ophthalmology residency, teach us how to prescribe. not just a simple lecture series.

i've seen far more neglegence in prescribing and treatment from OD's than ophthalmologists. it is true that there are bad ophthalmologists, but i'd rather have them prescibing medicine or performing surgery on me than a good OD.

Obviously, there were not a classes about spelling or grammar at your optom school.... I guess you were too busy taking pharmacology. Bottom line, through his management of this forum and responses to posts, Andrew has demonstrated intelligence and professionalism.

Instead of defending your tenuous position, why don't you SHOW us that you know what you are talking about...visit the Grand Rounds Pages and try to figure them out. With your hubris and fearlessness, I see many law suits in your future.

I'm afraid I have let my emotions get the best of me in the above comments, and perhaps in some previous posts.....dr. doan...I sincerely apologize and regret sounding like a bigot....I have worked very hard to feel competent providing my services to the American public, and unfortunately sometimes my passion for this profession fuels the fire for my emotions and anger at being questioned in my competence.....I have a huge amount of respect for omd's...there is no doubt about it, it is simply a fact, that the time you have invested in your training is longer than EVERY od....the environment is more competitive..etc....I understand how it would be frustrating to share the same title (doctor), with someone who hasn't put in the same amount of time, as you all have...I don't want to disrespect anyone...especially a group of people that I look up to and really do rely on....I honestly feel like I can help people with their sight....while in nursing school I wanted a profession that I felt was efficient and important, I felt that preserving or improving the function of the visual system was very important....in regards to the quality of a person's life........I don't want to argue with you guys, I just want to help people, and help preserve or improve the visual system of people...I know I can prescribe oral meds (with caution and respect for the side effects they may have)....I know I can do these non-surgical procedure if I had to (chalazion removal, lasik, yag)....I know that these non-surgical procedures are absolutely dangerous in the wrong hands.....and honestly I have no desire to do any of them....I am quiet happy prescribing contact lenses, glasses, treating glaucoma, and treating minor (but potentially major) eye inflammations or infections...etc....JJMD, shredhog65, mdkurt, exmike, and expecially Dr. Doan...PLEASE accept my apology if I offended you all. I will however, continue to stand my ground if you question my competence...

Dear Marley,

Thank you for your apology.

I understand that the issues we discuss in this forum can be frustrating and emotionally charged for the parties involved. We are not alone, however, in regards to our feelings when discussing issues related to scope of practice, optometric surgery, and prescription rights. After attending the American Academy of Ophthalmology Mid-Year Forum in Washington D.C. last month, I realized that the leaders in ophthalmology and optometry face similar frustrations when dealing with the same controversial issues. I hope that this forum will allow discussion from both sides so that students, residents, optometrists, and physicians can discuss and think about these important issues that will affect our futures and patient care.

I respect your passion for optometry and understand your frustrations. I know that it requires years of hard work as an undergraduate and four years of doctoral training to achieve the O.D. degree. However, before the ink dries on your diploma, you have other parties telling you what you can and cannot do as a Doctor of Optometry. This has to be difficult when you love your profession, and you want to serve society as a primary eye care doctor.

I also agree with you that the 40,000 optometrists and 14,000 ophthalmologists in the U.S. play important and unique roles in the delivery of ocular care. It will be crucial for our professions to work together in the next several decades as the baby boomers age. There will be several fold increase in ocular diseases like ARMD, diabetic retinopathy, glaucoma, and cataracts. Without a doubt, optometry will play an important role because ophthalmologists will have less time to treat minor ocular problems and screen the population for disease. As an ophthalmologist, I trust that optometrists will do an outstanding job as a primary care eye doctor with excellent clinical acumen. As I trust my internal medicine colleagues to consult general ophthalmology when there are serious ocular issues, I hope that optometrists will continue to do the same instead of trying to replace the comprehensive ophthalmologist.

honestly I have no desire to do any [surgeries]....I am quiet happy prescribing contact lenses, glasses, treating glaucoma, and treating minor (but potentially major) eye inflammations or infections.

I think you make an excellent point, and I think optometry, overall, does a great job screening for and treating the above problems. In fact, optometrists do a better job than ophthalmologists prescribing glasses and fitting contact lenses. I believe Dr. Hom made a good point previously about general ophthalmologists having a dispensary and how this is encroaching on optometry's territory. Perhaps general ophthalmologists should stop providing glasses in their office unless they are working with optometrists? One of my attendings no longer prescribes glasses. He refracts patients to determine their best-corrected visual acuities, and then returns the patient to the referring optometrist for the refraction and fitting of glasses. I have also adopted this philosophy if my patients regularly see an optometrist. As physicians, if we take a step back and give optometry the refractions and dispensing of glasses/contact lenses, then perhaps organized optometry will lessen their push for expansion of current scope of practice. Furthermore, I have no problems standing next to my optometry colleagues who are fighting to prevent opticians from being able to refract and dispense glasses. We can then concentrate on what we do best: the optometrist as a primary care eye doctor who prescribes contact lenses, glasses, treating minor ocular problems, treating early glaucoma, and treating minor eye inflammations or infections; and the ophthalmologist as the physician who treats serious ocular diseases and performs surgery.

I think the current balance in scope of practice determined for our professions is serving society well. There is no need for further expansion of scope of practice for optometry as observed in the State of Oklahoma. Because of the recent events in Oklahoma, I have established a firm and unyielding position in regards to legislation that allows optometrists, with a stroke of the pen, to perform ocular surgery and treat patients with dangerous oral medications.

I am aware of your training. I'm criticizing the article more than your profession. I do apologize if my post offends you Marley.

I respect the ODs I work with. They've all completed fellowships and are extremely competent. If you all want to have full prescription rights and deal with dangerous systemic medications and eye drops, then perhaps optometry should require all their graduates to complete a one-year fellowship. Less than 15% of optometrists are F.A.A.O., which is rather pathetic. No physician graduates from medical school and receives prescription rights without first completing at least a one-year internship.

FOr the record, residency training in optometry does not make someone FAAO, nor are all FAAO optometrists residency trained.

This is an interesting thread, but I'm going to disagree with the tone of it.

The term "optometric physician" did not come about because optometrists suddenly wanted to by "physicians." It came about because many 3rd party payers would not recognize, nor provide reimbursement to "non physician" providers. Using the term "optometric physician" was merely a way to obtain reimbursement from 3rd party payers. It doesn't make sense that a pediatrician can see all the conjunctivits patients he wants to, while ODs are excluded simply because they are "not physicians."

I also disagree with the sentiment about "surgery." For people who obtain a medical license, they are basically given a "carte blanche" license as soon as the ink is dry. That means that you are "licensed" to do brain surgery as soon as you obtain your medical license.

I don't know of any doctors who would practice beyond the scope of what they are comfortable doing, regardless of whether they are "licensed" or not.
Why do people think that ODs would be any different?

Jen

FOr the record, residency training in optometry does not make someone FAAO, nor are all FAAO optometrists residency trained.

I also disagree with the sentiment about "surgery." For people who obtain a medical license, they are basically given a "carte blanche" license as soon as the ink is dry. That means that you are "licensed" to do brain surgery as soon as you obtain your medical license.

Jen,

Thanks for the clarification about the FAAO. Regardless, less than 10-15% of all optometrists complete a residency. People on Capital Hill believe that most optometrists complete a residency like ophthalmologists.

In regards to "carte blanche" license, your statement above is not completely true. A new medical graduate couldn't get a job anywhere. A graduated intern may be able to work at a few places (but these opportunities are fewer each year due to regulations). A physician is not legal to do anything until after completion of a residency. In fact, hospitals will not give physicians privileges to perform brain surgery without the proper neuro-surgical training. It's possible that a FP may perform brain surgery in his/her own ASC, but I am sure he/she will not be practicing very long after a couple complications. Perhaps the fear of lawsuits will prevent optometrists from operating.

When all fields of medicine are facing increasing regulations and stricter competency requirements, why is optometry becoming less regulated by laws like the one observed in Oklahoma? Why is optometry different?

Jen,

Thanks for the clarification about the FAAO. Regardless, less than 10-15% of all optometrists complete a residency. People on Capital Hill believe that most optometrists complete a residency like ophthalmologists.

In regards to "carte blanche" license, your statement above is not completely true. A new medical graduate couldn't get a job anywhere. A graduated intern may be able to work at a few places (but these opportunities are fewer each year due to regulations). A physician is not legal to do anything until after completion of a residency. In fact, hospitals will not give physicians privileges to perform brain surgery without the proper neuro-surgical training. It's possible that a FP may perform brain surgery in his/her own ASC, but I am sure he/she will not be practicing very long after a couple complications. Perhaps the fear of lawsuits will prevent optometrists from operating.

When all fields of medicine are facing increasing regulations and stricter competency requirements, why is optometry becoming less regulated by laws like the one observed in Oklahoma? Why is optometry different?

I completely understand your statements regarding licensure, and credentialing, and privileges. The point that I was making was that from a "licensure" standpoint, it's carte blanche under state law. (please correct me if I am wrong.)

So again, why would anyone think that an OD would do anything that they feel they could not handle just because they are "licensed." Physicians don't do it, so why would ODs be any different.

Also, your statement about ODs and residency is not entirely correct. As it stands, only 10-15% of ODs currently practicing have completely a residency. Approximately 40-50% of new graduates are now completing them.

Jen

Dear Dr. Doan,
Thank you for your insightful comments. It is always a pleasure to read such logical and thoughful comments and it proves to me that despite all the heated and often emotional debates that take place on this forum, we can stay professional and have meanigful conversations.
As an Optometrist who has an uncle and three cousines who are all practicing Ophthos in NY, all of whom are married to Opthomologists as well, I have the outmost respect for your profession. Being exposed to so much Ophthalmology growing up, I consiously decided to pursue my education in Optometry, because I didn't want to do surgery. I was very much fascinated with the field of vision science and wanted to be able to apply it in a clinical setting; thus, Optometry was the very logical career choice for me and I am very happy with my decision. And as a matter of fact, expanding on my knowledge of Optics, I am starting my masters in Astro-Physics on part-time basis this September, which I am very excited about. One of the key aspects of Optometry that I enjoy is patient care, which goes very much hand in hand with the fundemental consept of "do no harm" that I hold very dearly. Having said that, most of my colleagues and I, would never want to do anything to harm our patients. Even for something like a difficult Kerataconic RGP fitting, I try to refer my patient to an Optometrist who has special interest in CL and has done residency in this field, because I think that will be the best for my patient. By the same token, I get lots of referrals from other ODs and MDs for Low Vision patients, which is my area of special interest. My point being that for something as serious and invasive as surgery, I would never pretend to be an expert and I would never want to perform any procedure on my patients, if I don't have the proper training for it. As it has been already said many of times in this forum, we already have professionals who are specilized to do ocular surgeries and they are called Ophthalmologists, and I believe, it is only fair to the patient to be referred to a surgeon for surgery. The problem of underserviced areas, also exist here in Canada, and the governement tries to attract more young Ophthalmologists to these areas by offering attarctive tax relief, travel expenses, etc. I don't believe lowering the standards of care will solve the problem. Many of my colleagues and I have written to the Oklahoma Association of Optometrist Physicians expressing our concerns over the recent bill. We don't believe this is the directions our profession, Optometry, shoule take and I really do believe this is the feeling of most my collegues in North America. I think surgery should be were we draw the line. At the same time, Ophthalmologists should recognize the service that is provided to the public by Optometrists and stop fighting for the sake of fighting. Unfortunately, in some of the Canadian provinces, few Ophthos are working with Opticians and optical chains to assist Opticians gain privilages to refract independently. Some of those Ophthos are supproting this cause, just out of animosity they have towards Optometry, knowing that it is patients who will suffer at the end of the day. Providing primary care and dispensing by many ophthos in large urban centers in Canada is also another source of conflict that is slowly disappearing due to acute shortage of surgeons in Canada. If Ophthomologists and Optometrists work together and as you said support each other in providing the best care to their patients, I believe with the baby boomers there will be more than enough patients for both professions and each profession will get to practice what they are trained to do and what they love to do side by side.
I thank you once again for listening and thinking about the root of many of the so called "turf war" discussions. I hope I am making sense here. I need to get back to work.

Kindest Regards,
Dr. M.

The point that I was making was that from a "licensure" standpoint, it's carte blanche under state law. (please correct me if I am wrong.)

So again, why would anyone think that an OD would do anything that they feel they could not handle just because they are "licensed." Physicians don't do it, so why would ODs be any different.

Yes, a medical license is a kind of a carte blanche, but there have been established mechanisms to determine what physicians are able to do and not able to. In addition, medical graduates are educated in surgical and non-surgical medicine; thus, the medical degree includes these privileges.

On the other hand, optometrists are NOT surgeons and do not receive education in surgery nor extenstive training in systemic illnesses. Why should a law permit optometrists to have a license for something they are not trained for? In Oklahoma, for instance, a law instantly grants these privileges to a group of non-surgeons and non-physicians. I think the solution is simple. If you want to do surgery, then you should go to medical school and complete an ophthalmology residency.


Also, your statement about ODs and residency is not entirely correct. As it stands, only 10-15% of ODs currently practicing have completely a residency. Approximately 40-50% of new graduates are now completing them.

I think you should do a little research before you assume 40-50% of new optometry graduates are completing residencies. Currently, there are only enough residency positions for 15% of the graduating class to complete a residency.

http://www.opted.org/residencies_faq.cfm



How many residency programs and positions presently exist?

Currently, there are 113 accredited optometric residency programs affiliated with a school or college of optometry. Other non-accredited residency programs also are available, and information on both accredited and non-accredited programs can be accessed through ASCO's Online Residency Program Directory at www.opted.org. Some residencies offer more than one position, so there are close to 200 total residency positions within both accredited and non-accredited residency programs. This number is contrasted with the more than 1,300 graduates of schools and colleges of optometry (current enrollment levels in the United States).


Therefore, only 15% of all optometrists (new graduates too) can complete a one-year "residency" program.

Dear Dr. Doan,
Thank you for your insightful comments. It is always a pleasure to read such logical and thoughful comments and it proves to me that despite all the heated and often emotional debates that take place on this forum, we can stay professional and have meanigful conversations.
As an Optometrist who has an uncle and three cousines who are all practicing Ophthos in NY, all of whom are married to Opthomologists as well, I have the outmost respect for your profession. Being exposed to so much Ophthalmology growing up, I consiously decided to pursue my education in Optometry, because I didn't want to do surgery. I was very much fascinated with the field of vision science and wanted to be able to apply it in a clinical setting; thus, Optometry was the very logical career choice for me and I am very happy with my decision. And as a matter of fact, expanding on my knowledge of Optics, I am starting my masters in Astro-Physics on part-time basis this September, which I am very excited about. One of the key aspects of Optometry that I enjoy is patient care, which goes very much hand in hand with the fundemental consept of "do no harm" that I hold very dearly. Having said that, most of my colleagues and I, would never want to do anything to harm our patients. Even for something like a difficult Kerataconic RGP fitting, I try to refer my patient to an Optometrist who has special interest in CL and has done residency in this field, because I think that will be the best for my patient. By the same token, I get lots of referrals from other ODs and MDs for Low Vision patients, which is my area of special interest. My point being that for something as serious and invasive as surgery, I would never pretend to be an expert and I would never want to perform any procedure on my patients, if I don't have the proper training for it. As it has been already said many of times in this forum, we already have professionals who are specilized to do ocular surgeries and they are called Ophthalmologists, and I believe, it is only fair to the patient to be referred to a surgeon for surgery. The problem of underserviced areas, also exist here in Canada, and the governement tries to attract more young Ophthalmologists to these areas by offering attarctive tax relief, travel expenses, etc. I don't believe lowering the standards of care will solve the problem. Many of my colleagues and I have written to the Oklahoma Association of Optometrist Physicians expressing our concerns over the recent bill. We don't believe this is the directions our profession, Optometry, shoule take and I really do believe this is the feeling of most my collegues in North America. I think surgery should be were we draw the line. At the same time, Ophthalmologists should recognize the service that is provided to the public by Optometrists and stop fighting for the sake of fighting. Unfortunately, in some of the Canadian provinces, few Ophthos are working with Opticians and optical chains to assist Opticians gain privilages to refract independently. Some of those Ophthos are supproting this cause, just out of animosity they have towards Optometry, knowing that it is patients who will suffer at the end of the day. Providing primary care and dispensing by many ophthos in large urban centers in Canada is also another source of conflict that is slowly disappearing due to acute shortage of surgeons in Canada. If Ophthomologists and Optometrists work together and as you said support each other in providing the best care to their patients, I believe with the baby boomers there will be more than enough patients for both professions and each profession will get to practice what they are trained to do and what they love to do side by side.
I thank you once again for listening and thinking about the root of many of the so called "turf war" discussions. I hope I am making sense here. I need to get back to work.

Kindest Regards,
Dr. M.

Dr. M,

Thank you for your opinion. I value your experience and wisdom. Ophthalmology and optometry need to unite and work together, instead of fighting over for "turf". :thumbup:

If you want to do surgery, then you should go to medical school and complete an ophthalmology residency.

I think you should do a little research before you assume 40-50% of new optometry graduates are completing residencies. Currently, there are only enough residency positions for 15% of the graduating class to complete a residency.

http://www.opted.org/residencies_faq.cfm



How many residency programs and positions presently exist?

Currently, there are 113 accredited optometric residency programs affiliated with a school or college of optometry. Other non-accredited residency programs also are available, and information on both accredited and non-accredited programs can be accessed through ASCO's Online Residency Program Directory at www.opted.org. Some residencies offer more than one position, so there are close to 200 total residency positions within both accredited and non-accredited residency programs. This number is contrasted with the more than 1,300 graduates of schools and colleges of optometry (current enrollment levels in the United States).


Therefore, only 15% of all optometrists (new graduates too) can complete a one-year "residency" program.

Don't take everything you read on the internet at face value.

That page that you are quoting was last updated in 2001. Just by doing a simple search, I found over 140 "residencies" many of which have multiple residency positions. That's obviously much more than the 113 quoted. There are over 30 positions with the IHS in Arizona alone. And ASCO is only going to post residencies that THEY accredit. In fact, many of the non accredited ones are under the supervision of ophthalmologists, and this is often times the reason that they are not accredited.

And I don't agree that ONLY medical school can be a place to become a surgeon. Even a competent eye surgeon. If that were the case, then we better start sending all those DDSs to medical school to learn how to do surgery. All those extractions and root canals could kill someone. Clearly, dental school is completely inadequate training for "tooth surgery."

Jen

Don't take everything you read on the internet at face value.

That page that you are quoting was last updated in 2001. Just by doing a simple search, I found over 140 "residencies" many of which have multiple residency positions. That's obviously much more than the 113 quoted. There are over 30 positions with the IHS in Arizona alone. And ASCO is only going to post residencies that THEY accredit. In fact, many of the non accredited ones are under the supervision of ophthalmologists, and this is often times the reason that they are not accredited.

And I don't agree that ONLY medical school can be a place to become a surgeon. Even a competent eye surgeon. If that were the case, then we better start sending all those DDSs to medical school to learn how to do surgery. All those extractions and root canals could kill someone. Clearly, dental school is completely inadequate training for "tooth surgery."

Jen

Jen,

Please show me the data that 40-50% of optometry graduates pursue residency training. I highly doubt this from speaking with recent graduates. In addition, if you increase the number of optometric residents from 200 yearly to 600 yearly, then 400 residents are likely working for free, which makes it less likely that there are 600 optometric residents per year. Some of the 200 positions indicated above are already unfunded positions, and funding for residencies is tough to come by. Also, I doubt that there are 400 new optometric residencies developed since 2001 that are accredited. What kind of standards and quality are you subjecting graduates in an un-accredited program? The public would never tolerate un-accredited ophthalmology programs for eye surgeons. In addition, I think "residencies" at a private, un-accredited clinic may not provide the breadth and diversity of pathology needed to train competent clinicians.

Please spare me the argument that DDS are not surgeons. Their curriculum prepares them to perform oral surgery, and dentistry has been established as a surgical subspecialty for over 200 years. DDSs are trained by faculty who are oral surgeons. Furthermore, OMFS surgeons also complete a comprehensive medical internship and surgical residency at ACGME credited institutions. The same argument can be made for osteopathic graduates.

How long as optometry been training surgeons or preparing optometric graduates for surgery? The answer is simple: never.

If optometry education does not provide the necessary fundamentals to pursue a surgical and comprehensive medical career, then what makes you think optometrists should be allowed to perform surgeries?

And I don't agree that ONLY medical school can be a place to become a surgeon. Even a competent eye surgeon. If that were the case, then we better start sending all those DDSs to medical school to learn how to do surgery. All those extractions and root canals could kill someone. Clearly, dental school is completely inadequate training for "tooth surgery."


A general dentist spends four years learning & practicing the various aspects of dentistry, including both invasive & noninvasive treatments. We're also required to perform a variety of direct & indirect operative treatments on patients as part of our licensure examinations. Oral & maxillofacial surgeons receive a *minimum* of four further years of residency training to receive their OMS certifications, and furthermore dual-degree OMS complete a medical degree in addition to their postdoctoral surgery training. We're fully competent to diagnose, perform, and postoperatively manage the procedures we perform on patients.

Dr. Doan already mentioned this, but I'm chipping in since you're trying to drag my profession into the mire--research twice, argue once.

A general dentist spends four years learning & practicing the various aspects of dentistry, including both invasive & noninvasive treatments. We're also required to perform a variety of direct & indirect operative treatments on patients as part of our licensure examinations. Oral & maxillofacial surgeons receive a *minimum* of four further years of residency training to receive their OMS certifications, and furthermore dual-degree OMS complete a medical degree in addition to their postdoctoral surgery training. We're fully competent to diagnose, perform, and postoperatively manage the procedures we perform on patients.

Dr. Doan already mentioned this, but I'm chipping in since you're trying to drag my profession into the mire--research twice, argue once.


I think you missed the sarcasm. I'm not dragging your profession into the mire at all. In fact, I'm pointing out that there are many professionals out there performing very competent "surgery" without having done to medical school.

And that's the point. Too many people on these boards blather on and on about how MEDICAL SCHOOL is the ONLY WAY to become ANY SORT of competent surgeon, and dentists prove that wrong every day that they practice.

Jen

I think you missed the sarcasm. I'm not dragging your profession into the mire at all. In fact, I'm pointing out that there are many professionals out there performing very competent "surgery" without having done to medical school.

And that's the point. Too many people on these boards blather on and on about how MEDICAL SCHOOL is the ONLY WAY to become ANY SORT of competent surgeon, and dentists prove that wrong every day that they practice.

Jen
OK, but before you start proclaiming that you're every bit as "entitled" to perform ocular surgery as dentists are to perform oral surgery, you have a lot of explaining left to do. I can justify the dental profession's competency by summarizing its surgical/operative curriculum for you. If you're going to make the same claim for optometry, you need to be able to present equal justification. Ante up.

Dear Forum,

I believe that optometric residencies were originally designed to supplement and complement the pre-existing scope of practice of optometry, namely, traditional optometric skills such as contact lenses, binocular vision and low vision. Admittedly, the majority of optometric residencies do not concentrate on diseases management and detection. Only in the past 20 years, it seems that optometric residencies have started to focus on disease detection, "disease management", and advanced procedures. Still, residencies abound but emphasize the separate discplines of optometry.

This lack of uniformity in residency education and experience is a reflection to the dichotomy facing the optometric profession, namely traditional optometric skills vs. newly-defined medical scope of practice. This is unfortunate. Ophthalmologic residencies are uniform to a large extent and may reflect strengths or research interests of its clinical and basic science faculty.

That is not to day that there isn't any value to optometric residencies. They provide valuable experience that broadens the viewpoint of the optometric graduate and exposes the individual to a more varied faculty and patient mix.

This discourse is not a justification for any of the discussions of the current threads on this forum nor an excuse. It is just an explanation. Neither is the post meant to support or refute the merits of whether optometrists should or should not have expanded scope of practice.

Richard_Hom

I'm pointing out that there are many professionals out there performing very competent "surgery" without having done to medical school.

And that's the point. Too many people on these boards blather on and on about how MEDICAL SCHOOL is the ONLY WAY to become ANY SORT of competent surgeon
Jen

In my ophthalmology residency, I had the opportunity to work with OMFS residents and optometry students. I'd like to know what part of your optometric schooling has prepared you for, or even laid the groundwork for, surgery. I do think that anyone can learn surgery given the proper training. This theoretically wouldn't have to entail medical school, but right now this is the only avenue for safely training large groups of people how to do surgery. I don't know where you trained/are training, but what modifications do you think you'd need to learn surgery? What would you propose to teach optometrists the skills necessary to do surgery? An extra 40 hours of CME? 40 days? 4 years? It would require an entire overhaul of optometric education. It's tempting to look at a video and say "that's easy". Just remember that first you need to learn how to scrub.

In a previous discussion, it was brought up that nurses perform invasive procedures all the time. It is true that while a nurse may know how to perform these procedures, non-physician groups often dismiss the decision making process that leads to the ordering of a procedure. For instance, I was discussing this issue with a colleague, and she mentioned how some residents don't consider risks enough. In the case of central lines, while these are "easy" to place, they carry significant risks of sepsis and even death. I've seen patients who have died or became extremely ill because of an infected line.

All medical procedures and medications have associated risks. These risks are never truly appreciated until a practitioner sees enough and manages a large number of cases. I agree that residents don't consider these risks to the degree as their attendings, but I can guarantee you that residents will think twice before ordering a central line again after seeing patients die. The training physician will consider if the patient really needs IV access before consenting the patient or family. After seeing one patient die or severely injured under their care or one of their colleagues, I guarantee you that physicians will NEVER forget about the risks and complications associated with medications, procedures, or surgeries. This lesson cannot be learned from books, lectures, videos, or ?pocket guides?.

I was scrubbing into a case last night for a patient with severe endogenous endophthalmitis (infection of the eye) not responsive to a tap and inject of antibiotics on Monday. Our plan was for a diagnostic vitrectomy and injection of additional antibiotics with an antifungal. At this point, we do not know why this young patient has developed severe inflammation of her eye; however, my attending was teaching me how it is important to act quickly in the setting of an endophthalmitis. He emphasized that prompt action may not save sight, but it will help prevent the patient from dying by removing the source of infection. I was concentrating on saving vision in this woman that I almost forgot that she could die if I think too long. Nothing is a better teacher than humility while experiencing death and severe illness.

This is why we have implemented standardized training programs for training physicians and surgeons. People who haven't participated in the training as physicians will have difficulty understanding the importance of completing a residency and possibly fellowship. For ophthalmology, I will spend more than 4 years of post-graduate training after completing my residency. I will have managed over 10,000 patients medically and surgically. Over 95% of my patients have multiple ocular pathologies. While I can probably teach my kids to perform surgery, the decision making process and analysis before a medical or surgical treatment is delivered can only be taught in medical school, internship, residency, and for some, fellowship.

In the US, the training of medical doctors (MD and DO) and surgeons begin on day one of medical school and finishes on day 2920 for ophthalmologists, day 2555 for internists, and day 3285 for general surgeons. The training to become a physician and surgeon has been tested, strengthened, and proven for over one hundred years.

JennyW,

it is obvious that you are ignorant to the training of dentists. their curriculum is much more like an MD's than is your's. dental students are trained in the correct way to dispense systemic medication and to perform surgical proceedures. OD's are not - and no, your pharmacology course is not enough. this argument is an ongoing issue and many missinformed optometry students keep chiming in with their opinions. learn the facts before you make a point. when treating a patient, i hope you realize the difference between when you think you know something and when you really do know something.

JennyW,

it is obvious that you are ignorant to the training of dentists. their curriculum is much more like an MD's than is your's. dental students are trained in the correct way to dispense systemic medication and to perform surgical proceedures. OD's are not - and no, your pharmacology course is not enough. this argument is an ongoing issue and many missinformed optometry students keep chiming in with their opinions. learn the facts before you make a point. when treating a patient, i hope you realize the difference between when you think you know something and when you really do know something.

That's very interesting.

What exactly is "the correct way to dispense systemic medications?"

And what makes you think that OD schools are incapable of achieving the same goal?

Jen

In a previous discussion, it was brought up that nurses perform invasive procedures all the time. It is true that while a nurse may know how to perform these procedures, non-physician groups often dismiss the decision making process that leads to the ordering of a procedure. For instance, I was discussing this issue with a colleague, and she mentioned how some residents don't consider risks enough. In the case of central lines, while these are "easy" to place, they carry significant risks of sepsis and even death. I've seen patients who have died or became extremely ill because of an infected line.

All medical procedures and medications have associated risks. These risks are never truly appreciated until a practitioner sees enough and manages a large number of cases. I agree that residents don't consider these risks to the degree as their attendings, but I can guarantee you that residents will think twice before ordering a central line again after seeing patients die. The training physician will consider if the patient really needs IV access before consenting the patient or family. After seeing one patient die or severely injured under their care or one of their colleagues, I guarantee you that physicians will NEVER forget about the risks and complications associated with medications, procedures, or surgeries. This lesson cannot be learned from books, lectures, videos, or ?pocket guides?.

I was scrubbing into a case last night for a patient with severe endogenous endophthalmitis (infection of the eye) not responsive to a tap and inject of antibiotics on Monday. Our plan was for a diagnostic vitrectomy and injection of additional antibiotics with an antifungal. At this point, we do not know why this young patient has developed severe inflammation of her eye; however, my attending was teaching me how it is important to act quickly in the setting of an endophthalmitis. He emphasized that prompt action may not save sight, but it will help prevent the patient from dying by removing the source of infection. I was concentrating on saving vision in this woman that I almost forgot that she could die if I think too long. Nothing is a better teacher than humility while experiencing death and severe illness.

This is why we have implemented standardized training programs for training physicians and surgeons. People who haven't participated in the training as physicians will have difficulty understanding the importance of completing a residency and possibly fellowship. For ophthalmology, I will spend more than 4 years of post-graduate training after completing my residency. I will have managed over 10,000 patients medically and surgically. Over 95% of my patients have multiple ocular pathologies. While I can probably teach my kids to perform surgery, the decision making process and analysis before a medical or surgical treatment is delivered can only be taught in medical school, internship, residency, and for some, fellowship.

In the US, the training of medical doctors (MD and DO) and surgeons begin on day one of medical school and finishes on day 2920 for ophthalmologists, day 2555 for internists, and day 3285 for general surgeons. The training to become a physician and surgeon has been tested, strengthened, and proven for over one hundred years.

That story is fair enough Dr. Doan and your point is well taken, but there is a huge difference between that and removing a chalazion.

Jen

That's very interesting.

What exactly is "the correct way to dispense systemic medications?"

And what makes you think that OD schools are incapable of achieving the same goal?

Jen
The correct way to dispense systemic medications is with full awareness of their effects, indications, contraindications, mechanisms, etc. There's absolutely no reason why optometry schools *can't* do it, but that doesn't change the fact that they currently *don't*.

Furthermore, you haven't responded to the challenge, posed to you by myself and several others, to explain how optometry school prepares you to perform surgery.

JennyW,

it is obvious that you are ignorant to the training of dentists. their curriculum is much more like an MD's than is your's. dental students are trained in the correct way to dispense systemic medication and to perform surgical proceedures. OD's are not - and no, your pharmacology course is not enough. this argument is an ongoing issue and many missinformed optometry students keep chiming in with their opinions. learn the facts before you make a point. when treating a patient, i hope you realize the difference between when you think you know something and when you really do know something.


Hello all,

I'm not looking for arguments today... I just have a quick follow up question posed to anybody. Concerning the above statement, how are dentists trained to correctly dispense systemic medication? I think someone just answered how to correctly dispense it, I'm curious as to the training.

thanks

[QUOTE=aphistis]The correct way to dispense systemic medications is with full awareness of their effects, indications, contraindications, mechanisms, etc. There's absolutely no reason why optometry schools *can't* do it, but that doesn't change the fact that they currently *don't*.

QUOTE]

And you're making that statement based on what....??

Jen

And what makes you think that OD schools are incapable of achieving the same goal?

If you read my story above, then you will understand that it's the lack of standardized residency training and contact with ill patients in a hospital setting that makes OD less capable of prescribing systemic medications.

Have you medically managed any patients with: heart failure, severe asthma, hyperglycemia, hypoglycemia, severe hypertension, sepsis, immunosuppression, adrenal insufficiency, or hypotension? The medications OD and non-physicians seek to prescribe can have severe consequences. Without a medical internship and ophthalmology residency, it is difficult to learn how to master these medications, e.g. prednisone, diamox, and antibiotics. I'll reiterate again that one cannot learn how to prescribe systemic medications without a medical education, internship, and residency. I can teach you how to write: prednisone 80 mg PO QD; however, knowing when to prescribe and when to watch is part of the art of medicine that non-physicians quickly and wrongly dismiss as "trivial". The art of medicine can only be learned by managing thousands of patients with different problems.


That story is fair enough Dr. Doan and your point is well taken, but there is a huge difference between that and removing a chalazion.

Yes, I agree that removing a chalazion is different than doing intraocular, orbital, or periorbital surgery. If optometrists would like to expand their scope of practice, then I think it may be reasonable to form a joint board consisting of MDs, DOs, and ODs to determine what procedures and by what mechanisms these procedures will be taught to optometry. To date, there is no such board; thus, all surgical procedures, minor and major, should be reserved for physicians and surgeons trained to perform them.

What angers me and my colleagues is instead of forming a working relationship with ophthalmologists, optometry will aggressively lobby for legislation that grants them privileges. Read the new optometry law in Oklahoma. It's more than just chalazions the Oklahoma optometrists are seeking.

The law makers care about two things: votes and money. Optometry knows how to win the votes and gives a lot of money to law makers. In 1998, the Oklahoma optometrists were extremely organized. Many arranged closing of their offices and used portable exam lanes to provide free refractions for contact lenses and glasses for the law makers and their family members on the day the Oklahoma optometry laser bill passed. Each law maker also received checks and laser pointers too. I'm sure the law makers were thinking of the people of Oklahoma when they passed the law that allowed optometry to perform PRK refractive surgery. If access to care was their concern, then they achieved little because if patients couldn't afford to drive 3 hours to see an ophthalmologist, then they sure can't pay the thousands of dollars for refractive surgery.

If you're so passionate about performing chalazions, then I encourage you to work with the leadership of organized optometry and arrange a mechanism where MDs, DOs, and ODs can regulate the scope of practice. This would be a much better solution than turning to law makers to decide scope of practice decisions.

"... What angers me and my colleagues is instead of forming a working relationship with ophthalmologists, optometry will aggressively lobby for legislation that grants them privileges. Read the new optometry law in Oklahoma. It's more than just chalazions the Oklahoma optometrists are seeking. .."

"... What angers me and my colleagues is instead of forming a working relationship with ophthalmologists, optometry will aggressively lobby for legislation that grants them privileges. Read the new optometry law in Oklahoma. It's more than just chalazions the Oklahoma optometrists are seeking. .."

As always, your comments are cogent and relevant.

One notion is that there has been little negotiating with the various professional organizations at the pre legislative level and therefore there would seem to be little cooperation in a joint regulatory board. If only joint regulatory boards were truly cooperative, then this morass would not be upon us. Again, I predict that the only people who benefit from this fight are the legislators who are receiving a tremednous amount of PAC funds.

Richard_Hom

[QUOTE=aphistis]The correct way to dispense systemic medications is with full awareness of their effects, indications, contraindications, mechanisms, etc. There's absolutely no reason why optometry schools *can't* do it, but that doesn't change the fact that they currently *don't*.

QUOTE]

And you're making that statement based on what....??

Jen

many previous posts here by OD's describing how you are trained. what aphistis said pretty much sums it up.

Hello all,

I'm not looking for arguments today... I just have a quick follow up question posed to anybody. Concerning the above statement, how are dentists trained to correctly dispense systemic medication? I think someone just answered how to correctly dispense it, I'm curious as to the training.

thanks

Hi there,

To answer your question, dental students spend the latter half of dental school in clinic treating patients under the supervision of licensed faculty, similar (but not identical) to the relationship between resident & attending physicians. Restorative procedures obviously comprise a large percentage of treatment plans, but some patients require medication as part of their regimen. Commonly prescribed dental medications include narcotic & non-narcotic analgesics, anti-inflammatories, antibiotics, antifungals, anxiolytics, fluoride, and others I'm sure I'm forgetting. Students are responsible for devising treatment plans, with faculty signature approval (and countersignatures on prescriptions) as a regulatory mechanism.

Hope that helps!

To answer your question, dental students spend half of dental school in clinic treating patients under the supervision of licensed faculty, similar (but not identical) to the relationship between resident & attending physicians. Operative therapy obviously comprises a substantial fraction of treatments, but some patients require medication as part of their treatment regimen. Commonly prescribed dental medications include narcotic & non-narcotic analgesics, anti-inflammatories, antibiotics, antifungals, anxiolytics, fluoride, and others I'm sure I'm forgetting. Students are responsible for devising treatment plans, with faculty signature approval (and countersignatures on prescriptions) as a regulatory mechanism.

The supervision in dental school is similar to the relationship between medical students and attending physicians, not residents and attending physicians.

Medical residents can write orders and prescriptions without attending approval but under attending supervision.

I'm curious. Do dentists manage any systemic illnesses?

I think the main point is that dentists are trained for a surgical career with limited medical privileges. Similar to medicine, this training has been tested, strengthened, and proven for over 100 years. In addition, if dental graduates desire to perform more invasive surgeries then there are dental surgical fellowships and OMFS residencies. The OMFS residents complete a transitional year and work with medical residents. I worked with OMFS residents on the cardiology service. They also take call with us and manage patients.

The supervision in dental school is similar to the relationship between medical students and attending physicians, not residents and attending physicians.

Medical residents can write orders and prescriptions without attending approval but under attending supervision.


My mistake. I didn't realize med students became involved in patient care to that extent. Are students typically required to be primary caregiver on any of their rotations?



I'm curious. Do dentists manage any systemic illnesses?


To the extent that they present within our realm of expertise, yes, but not in the traditional see-your-internist-once-a-month sense. A number of diseases routinely present with oral manifestations, and we'll obviously address these in treatment. Further, systemic disease can obviously make a big impact in our treatment planning (med dosages for liver/kidney, premeds for some cardiac, inhalation sedation for lungs, hemostasis for anticoagulants, etc). But I can't think of a circumstance where a patient wouldn't be referred to physician for diagnosis & treatment if the dentist suspects an undiagnosed systemic condition.

With the notable exceptions of fluoride & periodontal maintenance treatment, most of our treatments are intended to be once-and-done, definitive treatments. We're not qualified to manage a patient's sarcoidosis any more than her rheumatologist could do a root canal.



I think the main point is that dentists are trained for a surgical career with limited medical privileges. Similar to medicine, this training has been tested, strengthened, and proven for over 100 years. In addition, if dental graduates desire to perform more invasive surgeries then there are dental surgical fellowships and OMFS residencies. The OMFS residents complete a transitional year and work with medical residents. I worked with OMFS residents on the cardiology service. They also take call with us and manage patients.

All true enough.

Thank you aphistis, your reply to my question is appreciated.

My question is, what makes optometry any less qualified than dentistry to prescribe medication, especially that which pertains to the eye and visual system? I mean, the statement earlier was that the dental education is way more like MDs and they are trained to correctly dispense.

No, one pharmacology course is not enough, but OD students spend at least their last year on rotations handling patients with supervision in much the same manner as dental students. Just like dentistry, some of that time is spent handling cases which require medication and sometimes those patients may have underlying (or obvious) systemic conditions. So what makes the OD education so inferior?

No, all curriculums are not the same between professions; why should they be, but that doesn?t mean the end result in some aspects are not the same. Hell even curriculums between medical schools differ-they have to, the same person isn?t teaching everywhere!

Like mentioned earlier if there is a problem in end-result competency, then we should work together to fix it-instead of pointing fingers and saying "they'll never get it right."

out for now

Thank you aphistis, your reply to my question is appreciated.

My question is, what makes optometry any less qualified than dentistry to prescribe medication, especially that which pertains to the eye and visual system? I mean, the statement earlier was that the dental education is way more like MDs and they are trained to correctly dispense.

No, one pharmacology course is not enough, but OD students spend at least their last year on rotations handling patients with supervision in much the same manner as dental students. Just like dentistry, some of that time is spent handling cases which require medication and sometimes those patients may have underlying (or obvious) systemic conditions. So what makes the OD education so inferior?

No, all curriculums are not the same between professions; why should they be, but that doesn?t mean the end result in some aspects are not the same. Hell even curriculums between medical schools differ-they have to, the same person isn?t teaching everywhere!

Like mentioned earlier if there is a problem in end-result competency, then we should work together to fix it-instead of pointing fingers and saying "they'll never get it right."

out for now
Before anything else, I want to emphasize here that I'm not trying to step on optometry as a profession. Also, the "a dentist's training is more like an MD's than an optometrist's" remark came from someone else, not me. I'm inclined to defer most of the rest to Dr. Doan, since he's much more familiar with this discussion than I am.

The question you raise at the end of your post, proper scope of practice, is what frames this entire debate. Does optometry education result in professional incomptency? That depends on how an optometrist's responsibilities to his/her patients are defined, and that in turn will depend primarily on whose definition is being used. There's no hope for a permanent, mutually agreeable solution to the problem unless or until that question can first be resolved to everyone's satisfaction, and I don't see that happening anytime soon.

Before anything else, I want to emphasize here that I'm not trying to step on optometry as a profession. Also, the "a dentist's training is more like an MD's than an optometrist's" remark came from someone else, not me.

I'm sorry--totally not directed towards you, sorry for the confusion.

"...Does optometry education result in professional incomptency? That depends on how an optometrist's responsibilities to his/her patients are defined, and that in turn will depend primarily on whose definition is being used..."

Dear aphistis,

I'm hoping that your statement was taken out of context. I don't believe that the education itself promotes incompetency. I believe that sufficient expereince in attained in well -defined roles and procedures and personal ethics are better gauges of competency than education itself. I don't wish to debate the majority of your comments except for the above. I'm sure that in the heat of the post our journalistic ethics may get the better of ones' self.

Of course my post does not support or refute the notion that optometrists should or should not have surgical privileges.

Richard_Hom

"...Does optometry education result in professional incomptency? That depends on how an optometrist's responsibilities to his/her patients are defined, and that in turn will depend primarily on whose definition is being used..."

Dear aphistis,

I'm hoping that your statement was taken out of context. I don't believe that the education itself promotes incompetency. I believe that sufficient expereince in attained in well -defined roles and procedures and personal ethics are better gauges of competency than education itself. I don't wish to debate the majority of your comments except for the above. I'm sure that in the heat of the post our journalistic ethics may get the better of ones' self.

Of course my post does not support or refute the notion that optometrists should or should not have surgical privileges.

Richard_Hom
Dr. Hom,

My intent in writing the excerpt you quoted was simply to illustrate that optometrists and opthalmologists don't always seem to agree on where the boundaries lie separating optometry from ophthalmology. I didn't intend to endorse or criticize either position. I hope this clears up any confusion.

Hi there,

To answer your question, dental students spend the latter half of dental school in clinic treating patients under the supervision of licensed faculty, similar (but not identical) to the relationship between resident & attending physicians. Restorative procedures obviously comprise a large percentage of treatment plans, but some patients require medication as part of their regimen. Commonly prescribed dental medications include narcotic & non-narcotic analgesics, anti-inflammatories, antibiotics, antifungals, anxiolytics, fluoride, and others I'm sure I'm forgetting. Students are responsible for devising treatment plans, with faculty signature approval (and countersignatures on prescriptions) as a regulatory mechanism.

Hope that helps!

Ok Bill.

If you substitute the word "dental" for the word "optometry" in your post, then your post would pretty much describe optometric training.

And I never meant to give the impression that optometric training allows for massively invasive procedures like the one Dr. Doan described earlier in this thread.

But it certainly provides for the removal of chalazions, foreign bodies, dialation and irrigation, and even *gasp* PIs and YAGs. These are procedures that have historically been considered "surgical."

How? Likely in the same way that dental is done. Through didactic training, clinical observation, and clinical performance under the supervision of experienced licensed faculty members, many of whom are ophthalmologists.

Jen

If you read my story above, then you will understand that it's the lack of standardized residency training and contact with ill patients in a hospital setting that makes OD less capable of prescribing systemic medications.

Yes, I agree that removing a chalazion is different than doing intraocular, orbital, or periorbital surgery. If optometrists would like to expand their scope of practice, then I think it may be reasonable to form a joint board consisting of MDs, DOs, and ODs to determine what procedures and by what mechanisms these procedures will be taught to optometry. To date, there is no such board; thus, all surgical procedures, minor and major, should be reserved for physicians and surgeons trained to perform them.

What angers me and my colleagues is instead of forming a working relationship with ophthalmologists, optometry will aggressively lobby for legislation that grants them privileges. Read the new optometry law in Oklahoma. It's more than just chalazions the Oklahoma optometrists are seeking.



In theory, that's not a bad idea, but in practice, I'm not so sure it would work well.

Unfortunately, ODs and OMDs have generally had a fractured relationship. From the time ODs wanted to expand their scope of practice to be able to check IOPs and do dilations, it has been a problems.

If you read some of the letters to the editor, and some of the position papers put out by the AAO from that time, the contention was that ODs would be at best blinding patients with proparacaine, and at worst, killing them with tropicamide. This probably set the stage for a poor relationship, and that is unfortunate.

Even today, in my home state of New York, OMDs are constantly going to court to have the removal of foreign bodies restricted because that's "surgery, despite the face that ODs in New York have successfully removed thousands. And even though ODs had successfully managed thousands of glaucoma patients, when Xalatan became available, a lawsuit was filed by OMDs trying to restrict ODs from continuing to manage glaucoma because in the original legislative formularly, "prostaglandin analogs" were not part of the formulary, and since ODs couldn't use the "most advanced" drugs, then they should be prohibited from using any. That doesn't make much sense. As much as it is argued that ODs try to expand their scope of practice "with the stroke of a pen" OMDs are constantly trying to RESTRICT scope of practice of procedures that have been done successfully for years "with the stroke of a pen."

At one point in time, it was considered "unethical" for OMDs to teach in a school of optometry. OMDs who did this could be sanctioned by their academy. I don't think that is still the case today, but that goes to show some of the history.

A collegue of mine who moved from New York to Reno Nevada told me that even though ODs in Nevada are technically allowed to treat glaucoma, in order to be licensed in Nevada to do this, they have to successfully "co-manage" a certain number of patients with an OMD for 2 years. (I think he said 15 patients.) The OMD was then supposed to sign off that they agreed with the ODs diagnosis and treatment. Well, you can guess how many OMDs cooperated with this scenario. Though my collegue had worked in the VA for 8 years and treated hundreds of patients for glaucoma, no OMD would comanage with him. One of his patients he suggested putting on Timolol, the OMD disagreed and gave the patient Betimol. THe OD did not get "credit" for this case. He had a similar patient a few days later that he suggested Betimol for (since this seemed to be the OMDs drug of choice) and, you guessed it, the OMD switched it to Timolol. Again, no credit.

When he asked the OMD if there was any clinical reason to make these changes, the OMD admitted that there wasn't. He just felt like it.

So again, that's just an anecdotal story, but OMDs don't exactly have a reputation for working with ODs unless the OD is supplying a steady stream of patients. So, I'm not so sure that a joint board would be effective.

Jen

There is a similar battle brewing between the psychiatrists and psychologists. Unfortunately, the psychiatrist posters in that forum have much less solidarity than that of the ophthalmologists. Sadly, ophthalmologists will lose this battle slowly. Optometrists will take lessons from the underhanded manner in which psychologists pass their prescribing laws.

http://pn.psychiatryonline.org/cgi/content/full/39/10/1

No legislator wants to be caught with their pants down during election year with the attack: "So, councellor X, your record indicates that you voted to cut access to quality healthcare for seniors."

Of course, if you have the stamina to read through the 10+ pages of post, you may form a different opinion.

Ok Bill.

If you substitute the word "dental" for the word "optometry" in your post, then your post would pretty much describe optometric training.

And I never meant to give the impression that optometric training allows for massively invasive procedures like the one Dr. Doan described earlier in this thread.

But it certainly provides for the removal of chalazions, foreign bodies, dialation and irrigation, and even *gasp* PIs and YAGs. These are procedures that have historically been considered "surgical."

How? Likely in the same way that dental is done. Through didactic training, clinical observation, and clinical performance under the supervision of experienced licensed faculty members, many of whom are ophthalmologists.

Jen

I'm in no position to pass judgment on where the line distinguishing optometry from opthalmology should be placed. However, I think you're confusing the actual scope of optometry relative to dentistry with what you think it *should* be.

I have no idea what chalazions are, what happens during a dilated exam, or what the acronyms PI or YAG even stand for; but I happen to agree strongly with Dr. Doan that essential criteria for scope-of-practice decisions should require the ability not only to perform the procedure normally, but also to manage complications that arise postoperatively.

Are optometrists qualified by that standard to do the things you mention? I have no idea. If so, then I have no grounds to object; if not, however, you owe it to your patients to swallow your pride, recognize your professional limitations, and refer to someone who *is* able to manage the patient's care.

but I happen to agree strongly with Dr. Doan that essential criteria for scope-of-practice decisions should require the ability not only to perform the procedure normally, but also to manage complications that arise postoperatively.

Bill, it is not my intention to drag you into this, I apologize, I merely would like to use your quote because this discussion seems to have gone astray...

I think everyone's ears perked up when the comment was made that- yes managing complications is a requirement and look at how well the dentists do it, they are trained similar to MD/DO, blahblah, but optometrists, no way, they are not trained correctly and haphazardly prescribe with no regard.

Then we compared training and what it takes, blah blah there are differences, but to say that the dental education trains dentists to prescribe medications within their scope yet realizing systemic conditions and the like, and the optometric education doesn't seems incorrect to me.

I think what I'm getting at is, it is my opinion that optometry should be able to serve its patients to the fullest scope, including the use of medications... If the training is under question, then steps should be made to make it adequate but to simply say "They are not trained like us, so no they are doing it wrong" is an incorrect assumption or even conclusion in this case


my humble two

bottom line on this one. OD's are not medically trained. It takes a deep understanding of the entire human body to correctly and safely dispense medication. OD's lack this. MD's complete an entire residency (4 years + more with fellowship) in order to perfect their surgical and medical skills. OD's do not. Until OD's start training this way, they will not be qualified to do the things ophthalmologists do.

OD's are very good at what they're trained to do. They're excellent at prescribing lenses, fitting contacts, low vision, etc. What they are not (as a whole) very good at is medical and surgical treatment of disease. There is a reason you get an MD, and there is a reason you get an OD. I know an OD who went to medical school in order to become an ophthalmologist. This person did this because med school and residency provide the training they needed to be compitent at medical and surgical diagnosis & treatment - OD school/ training did not.

bottom line - if you want to do the things that an ophthalmologist does, then go to medical school and get an ophtho residency. OD school doesn't train you effectively.

bottom line on this one. OD's are not medically trained. It takes a deep understanding of the entire human body to correctly and safely dispense medication. OD's lack this. MD's complete an entire residency (4 years + more with fellowship) in order to perfect their surgical and medical skills. OD's do not. Until OD's start training this way, they will not be qualified to do the things ophthalmologists do.

OD's are very good at what they're trained to do. They're excellent at prescribing lenses, fitting contacts, low vision, etc. What they are not (as a whole) very good at is medical and surgical treatment of disease. There is a reason you get an MD, and there is a reason you get an OD. I know an OD who went to medical school in order to become an ophthalmologist. This person did this because med school and residency provide the training they needed to be compitent at medical and surgical diagnosis & treatment - OD school/ training did not.

bottom line - if you want to do the things that an ophthalmologist does, then go to medical school and get an ophtho residency. OD school doesn't train you effectively.


ODs only do OD things and OMDs only do OMD things... I don't think so :rolleyes:

regarding medication, again I think what you are saying is "ODs dont do it like MDs, so no they can't do it"... so just to put you to task, you stated earlier that dentists are trained in the "correct way to dispense systemic medication" and just now that it takes "deep understanding of the entire human body" doesn't describe dentists to me, but I dont want to get into that I just want to point out that it only seems to raise suspicion when there is a turf war at hand. hmmm

The supervision in dental school is similar to the relationship between medical students and attending physicians, not residents and attending physicians.

Medical residents can write orders and prescriptions without attending approval but under attending supervision.

I'm curious. Do dentists manage any systemic illnesses?

I think the main point is that dentists are trained for a surgical career with limited medical privileges. Similar to medicine, this training has been tested, strengthened, and proven for over 100 years. In addition, if dental graduates desire to perform more invasive surgeries then there are dental surgical fellowships and OMFS residencies. The OMFS residents complete a transitional year and work with medical residents. I worked with OMFS residents on the cardiology service. They also take call with us and manage patients.

i think this sums it up. as for dentists managing systemic illnesses - i am not a dentist, but my grandfather is, and he has diagnosed (not managed though) many systemic diseases - especially autoimmune plus coagulopathies/ and hematopeitic disturbabnces. i guess the amount of bleeding during proceedures can tell you alot.

i think this sums it up. as for dentists managing systemic illnesses - i am not a dentist, but my grandfather is, and he has diagnosed (not managed though) many systemic diseases - especially autoimmune plus coagulopathies/ and hematopeitic disturbabnces. i guess the amount of bleeding during proceedures can tell you alot.


Do you think they just set OD students loose... They spend at least their fourth year, in its entirety, involved in the same type of relationship.

Even today, in my home state of New York, OMDs are constantly going to court to have the removal of foreign bodies restricted because that's "surgery, despite the face that ODs in New York have successfully removed thousands. And even though ODs had successfully managed thousands of glaucoma patients, when Xalatan became available, a lawsuit was filed by OMDs trying to restrict ODs from continuing to manage glaucoma because in the original legislative formularly, "prostaglandin analogs" were not part of the formulary, and since ODs couldn't use the "most advanced" drugs, then they should be prohibited from using any. That doesn't make much sense. As much as it is argued that ODs try to expand their scope of practice "with the stroke of a pen" OMDs are constantly trying to RESTRICT scope of practice of procedures that have been done successfully for years "with the stroke of a pen."

At one point in time, it was considered "unethical" for OMDs to teach in a school of optometry. OMDs who did this could be sanctioned by their academy. I don't think that is still the case today, but that goes to show some of the history.

A collegue of mine who moved from New York to Reno Nevada told me that even though ODs in Nevada are technically allowed to treat glaucoma, in order to be licensed in Nevada to do this, they have to successfully "co-manage" a certain number of patients with an OMD for 2 years. (I think he said 15 patients.) The OMD was then supposed to sign off that they agreed with the ODs diagnosis and treatment. Well, you can guess how many OMDs cooperated with this scenario. Though my collegue had worked in the VA for 8 years and treated hundreds of patients for glaucoma, no OMD would comanage with him. One of his patients he suggested putting on Timolol, the OMD disagreed and gave the patient Betimol. THe OD did not get "credit" for this case. He had a similar patient a few days later that he suggested Betimol for (since this seemed to be the OMDs drug of choice) and, you guessed it, the OMD switched it to Timolol. Again, no credit.


Jen,

You make very good points. Perhaps we need new leadership on both sides to develop a working relationship and stop this ridiculous fighting between our professions. I strongly believe that the solution may be found in our professions working together.

I think optometrists can manage minor problems with drops and oral meds. However, optometrists must also realize their limits. Certain medications like oral prednisone and immunosuppressives should only be used by medical doctors who have treated thousands of patients with these medications. The nature of our profession divides the patient population into two groups:mainly healthy individuals and others who have serious pathology. Optometrists do a wonderful job screening and treating minor pathology in the group consisting of mainly healthy individuals, and ophthalmologists are competent with treating patients with serious pathology. This is not because optometrists are "less intelligent" but rather it's a manifestation of the differences in our training programs.

Furthermore, it's interesting that there are groups of optometrists who want more medical privileges, but there are many who will not accept responsibility in court. Many of my faculty have been expert witnesses, and when the optometrist is sued, he/she often claims that it's not within his/her scope of practice. The lawyers then go after the physician instead. This is one of the main reasons why optometrists can claim years of no complications and pay only $400/year in malpractice.

wow!
SDN ophthalmology threads are WAAAY more interesting than the OD threads.... :laugh:

I think optometrists can manage minor problems with drops and oral meds. However, optometrists must also realize their limits. Certain medications like oral prednisone and immunosuppressives should only be used by medical doctors who have treated thousands of patients with these medications. The nature of our profession divides the patient population into two groups:mainly healthy individuals and others who have serious pathology. Optometrists do a wonderful job screening and treating minor pathology in the group consisting of mainly healthy individuals, and ophthalmologists are competent with treating patients with serious pathology. This is not because optometrists are "less intelligent" but rather it's a manifestation of the differences in our training programs.

Furthermore, it's interesting that there are groups of optometrists who want more medical privileges, but there are many who will not accept responsibility in court. Many of my faculty have been expert witnesses, and when the optometrist is sued, he/she often claims that it's not within his/her scope of practice. The lawyers then go after the physician instead. This is one of the main reasons why optometrists can claim years of no complications and pay only $400/year in malpractice.


great post

to clarify the debate about residencies for optometrists.. there's no WAY it's 40% of graduating ODs. Like the early post said there are only 130 slots for residency.. and in my fouth year class there are only 10 students thinking of applying for one. (which is only 13% of my class).

This was posted in the optometry forum.

http://forums.studentdoctor.net/showthread.php?t=123623
http://www.revoptom.com/drugguide.asp?show=view&articleid=2

I find it rather disturbing when an article "teaches" optometrists how to prescribe medications like prednisone without much emphasis on the systemic side effects. :eek:

"Optometric physicians and their patients are enjoying the huge benefits of topically applied medications. Now it's time to fully embrace a different route of administration: the orally administered medicines. So that we can put this subset of drugs in perspective, realize that the internist must master hundreds of medicines; we only need to master a baker's dozen (give or take) to treat the vast majority of ophthalmic diseases."

The term optometric physicians appears again. Way to blur the lines even more! :rolleyes:

Dr Doan,
Would you please post the type/amount and number of cases managed that allows you to fit rigid gas permeable lenses on an irregular astigmatic patient. Improper fit could lead to scarring and resultant PK transplant. Also same question for number of cases you personally fit the patient with eyeglasses, including all seg height measurments, PD and lens decentration, as well as you advice on which progressive add to use. Perhaps I should address this to the Contact Lens Association of Ophthalmologists or the Dispensing Ophthalmologist Association. WHO is blurring the lines??

I agree with the above. I don't think ophthalmologists should dispense glasses or contact lenses. In a symbiotic world, there should be lines drawn for surgery as well as dispensing glasses.

Jen,

You make very good points. Perhaps we need new leadership on both sides to develop a working relationship and stop this ridiculous fighting between our professions. I strongly believe that the solution may be found in our professions working together.

Furthermore, it's interesting that there are groups of optometrists who want more medical privileges, but there are many who will not accept responsibility in court. Many of my faculty have been expert witnesses, and when the optometrist is sued, he/she often claims that it's not within his/her scope of practice. The lawyers then go after the physician instead. This is one of the main reasons why optometrists can claim years of no complications and pay only $400/year in malpractice.

Dr Doan
I guess I don't understand your comment above. An OD treats a patient, it causes such complications that the OD is sued. The OD stands in court and says "Its not within my scope"?? The law has Ipso-Facto rule that says "the thing speaks for itself"--You Did It !!. You can't do something, then claim it was out of your scope as a defense. Could the low claim rate and low cost of malpractice be because---when practicing primary care, ODs are doing a good job??!! (I have 2 million/occurance for $800/yr. AND specific clauses that prevent coverage for surgery (as traditionally defined). If I step outside my scope, I'm not even covered.

Dr Doan
I guess I don't understand your comment above. An OD treats a patient, it causes such complications that the OD is sued. The OD stands in court and says "Its not within my scope"?? The law has Ipso-Facto rule that says "the thing speaks for itself"--You Did It !!. You can't do something, then claim it was out of your scope as a defense. Could the low claim rate and low cost of malpractice be because---when practicing primary care, ODs are doing a good job??!! (I have 2 million/occurance for $800/yr. AND specific clauses that prevent coverage for surgery (as traditionally defined). If I step outside my scope, I'm not even covered.
I read that and was confused as well. The only time an OD would be able to say it was beyond his/her scope would be if it truely was and the patient was referred to the proper OMD and that OMD made a mistake. For example, if I have a patient with advanced glaucoma with IOP's of 28 OU on three meds I would refer to the glaucoma specialist in town. If the patient goes blind while in her care and then he sues, I will be named as well. My defense will be that the patient needed surgical intervention and that is beyond my scope. My referral to the glaucoma specialist was the correct course of action, and I am not liable once she assumed care for the patient (as long as I correctly managed the IOP until it no longer responded to medical therapy). In that case I would be saying "it was not within my scope" not because I performed a trab and it failed, but because I am not allow to perform trabs, so I did not. I have never heard of a case where an OD performed a procedure, made a mistake and then claimed no liability because it was not within his scope. If it wasn't within his scope, not only would he still be liable, but he would have also been guilty of practicing medicine without a license.

to clarify the debate about residencies for optometrists.. there's no WAY it's 40% of graduating ODs. Like the early post said there are only 130 slots for residency.. and in my fouth year class there are only 10 students thinking of applying for one. (which is only 13% of my class).

cpw,
this is just a side question:
is there a discussion about OD residencies on the forum? advantages/disadvantages? where can i go to read up on that?
and on a personal note, can you tell me again whether you've decided to do a residency?

Dr Doan
I guess I don't understand your comment above. An OD treats a patient, it causes such complications that the OD is sued. The OD stands in court and says "Its not within my scope"?? The law has Ipso-Facto rule that says "the thing speaks for itself"--You Did It !!. You can't do something, then claim it was out of your scope as a defense. Could the low claim rate and low cost of malpractice be because---when practicing primary care, ODs are doing a good job??!! (I have 2 million/occurance for $800/yr. AND specific clauses that prevent coverage for surgery (as traditionally defined). If I step outside my scope, I'm not even covered.

Consider this scenario, OD misses diagnosis, patient gets treated via surgery by a surgeon, and the outcome is bad because the disease is advanced. Lawyer and patient sues surgeon and OD. OD claims it is beyond scope and states that the MD is the expert. There is jury that likes the patient and the surgeon has to pay. It happens like this all the time.

Consider this scenario, OD misses diagnosis, patient gets treated via surgery by a surgeon, and the outcome is bad because the disease is advanced. Lawyer and patient sues surgeon and OD. OD claims it is beyond scope and states that the MD is the expert. There is jury that likes the patient and the surgeon has to pay. It happens like this all the time.

It seems like this same scenario could be played about between primary care physicians and other various surgeons/specialists as well. Does this "blame the guy higher up the line" mentality happen outside optometry/ophthalmology?

Consider this scenario, OD misses diagnosis, patient gets treated via surgery by a surgeon, and the outcome is bad because the disease is advanced. Lawyer and patient sues surgeon and OD. OD claims it is beyond scope and states that the MD is the expert. There is jury that likes the patient and the surgeon has to pay. It happens like this all the time.

Dr. Doan,

As usually happens on these boards, I'm going to have to ask for something more than "it happens all the time", anecdotal evidence. Is it possible that the surgeon AND the OD have to pay, but since you know the surgeons better than the ODs, you don't hear about the judgments against them?

I do agree that juries often have little grasp of the complexities of these cases, e.g. bad disease often equals bad surgical outcome. But for the OD to get off the hook is wrong, IF they missed disease early.

And some of these cases might not be the ODs fault on closer inspection. For example, patient presents with flashes/floaters, OD does scleral depression, no breaks seen, follow up scheduled. Over next week, patient develops macula off detachment from fresh break but fails to call OD (thought it would get better syndrome). At your university clinic, I'd imagine you tend to see these kinds of disasters. So maybe in some of these cases there was no disease to miss or misdiagnose at initial presentation.

Again, just playing devil's advocate and asking for more than anecdotal evidence.

Tom Stickel
Indiana U. School of Optometry, 2001

I read that and was confused as well. The only time an OD would be able to say it was beyond his/her scope would be if it truely was and the patient was referred to the proper OMD and that OMD made a mistake. For example, if I have a patient with advanced glaucoma with IOP's of 28 OU on three meds I would refer to the glaucoma specialist in town. If the patient goes blind while in her care and then he sues, I will be named as well. My defense will be that the patient needed surgical intervention and that is beyond my scope. My referral to the glaucoma specialist was the correct course of action, and I am not liable once she assumed care for the patient (as long as I correctly managed the IOP until it no longer responded to medical therapy). In that case I would be saying "it was not within my scope" not because I performed a trab and it failed, but because I am not allow to perform trabs, so I did not. I have never heard of a case where an OD performed a procedure, made a mistake and then claimed no liability because it was not within his scope. If it wasn't within his scope, not only would he still be liable, but he would have also been guilty of practicing medicine without a license.


I agree Ben; an OD will get sued along with the OMD when a liability suit is filed. In most malpractice cases lawyers go after everyone, even a PCP if they can. Lawyers assess the % of fault each doctor had in contributing to the patient’s ill fate. The OMD will have the largest percentage because they were the last person that treated the patent. This would also be the case if the OD were the last person to treat the patient. Another interesting note is that OD’s will get slapped a healthy liable percent for making the wrong referral. I know an OD that was found 35% liable for referring an RD, macula off to general OMD and not directly to a retinal sub-specialist.

cpw,
this is just a side question:
is there a discussion about OD residencies on the forum? advantages/disadvantages? where can i go to read up on that?
and on a personal note, can you tell me again whether you've decided to do a residency?

I considered doing a residency and then decided against it. Many of my classmates decided to do one in various fields. many of them are under the dilusion it's going to help them find jobs in already saturated areas. While it might , it's no guarantee. If doctors like you, you'll find somewhere to work. (either through personal searching, or word of mouth.... optometry is not that big of a ballgame)

I personally, had offers to work after my fourth year externships. So, doing a residency wasn't going to make me more competitive and I'm learning tons working with residency trained ODs. But, I do plan on trying to get into the FAAO. (they do have the best CE locations) ;)

There usually is a residency discussion on the forum. Try doing a SDN search for previous conversations.

It seems like this same scenario could be played about between primary care physicians and other various surgeons/specialists as well. Does this "blame the guy higher up the line" mentality happen outside optometry/ophthalmology?

Yes this happens within the realm of nurse midwifes and OB/GYNs with frequency.

After reading these threads, I think it is scary that any health care professional that has not completed a medical internship, would prescribe systemic meds, like prednisone and/or abx.

Those that do this have absolutely no clue about all the serious adverse rxns that can happen. After completing 4 yrs of medical school training, I was still so unprepared to treat pts with systemic meds (even the so called benign ones) at the start of my internship year.

One can read an entire textbook about the adverse effects of certain meds but it really is not until you see these things that you can truly identify them.

Cushing's syndrome, secondary adrenal insuff, c-diff colitis, liver failure, renal failure, syncope, hemolytic anemia, heart failure, so on and so on. I have seen and treated these diseases, all of which were drug induced.

The privilege to rx systemic meds should not be taken so lightly. Giving a med even like NSAIDs can cause very severe problems (ie, ARF in the elderly).

Would an OD know to ask a pt if they were on an ACE-I prior to starting an NSAID?

Prednisone and certain abx can cause even worse problems. It is impossible to recognize these effects, when you have never seen it.

Also, what about all the other meds the pt is on? Would an OD know about the various interactions/contraindications when dealing with multiple other non ocular systemic meds?

Simply referring to the primary doc is a poor answer. The issue is to recognize the risks or the development of these adverse effects and choose the correct med or make the appropriate changes before the problem arises.

There is no question in my mind that an OMD is better qualified to rx systemic meds than an OD. If you do not agree, then I welcome you to shadow a medical intern and see for yourself the difference in training.

After reading these threads, I think it is scary that any health care professional that has not completed a medical internship, would prescribe systemic meds, like prednisone and/or abx.


Uh-oh.....I'm bracing for the storm that is sure to follow this post :rolleyes: I agree with you on many points ReMD, but my experience has been that these are difficult points to impress upon those health care professionals who have not completed (or plan to complete) a medical or surgical internship. These forum wars, though entertaining usually degenerate into comparing OD vs OMD education, name calling and putting many of the ODs on the defensive re: their own education (how many times do we need to hear that so and so graduated magna cum laude from such and such ivy league? ;) ). A little unsolicited advice: one wise person on this forum once told me to focus our attentions on "drawing the line at surgery." When you look at many of the OD vs. OMD battles from this perspective, I find it easier to concede some of these other issues.

After reading these threads, I think it is scary that any health care professional that has not completed a medical internship, would prescribe systemic meds, like prednisone and/or abx.

Those that do this have absolutely no clue about all the serious adverse rxns that can happen. After completing 4 yrs of medical school training, I was still so unprepared to treat pts with systemic meds (even the so called benign ones) at the start of my internship year.

One can read an entire textbook about the adverse effects of certain meds but it really is not until you see these things that you can truly identify them.

Cushing's syndrome, secondary adrenal insuff, c-diff colitis, liver failure, renal failure, syncope, hemolytic anemia, heart failure, so on and so on. I have seen and treated these diseases, all of which were drug induced.

The privilege to rx systemic meds should not be taken so lightly. Giving a med even like NSAIDs can cause very severe problems (ie, ARF in the elderly).

Would an OD know to ask a pt if they were on an ACE-I prior to starting an NSAID?

Prednisone and certain abx can cause even worse problems. It is impossible to recognize these effects, when you have never seen it.

Also, what about all the other meds the pt is on? Would an OD know about the various interactions/contraindications when dealing with multiple other non ocular systemic meds?

Simply referring to the primary doc is a poor answer. The issue is to recognize the risks or the development of these adverse effects and choose the correct med or make the appropriate changes before the problem arises.

There is no question in my mind that an OMD is better qualified to rx systemic meds than an OD. If you do not agree, then I welcome you to shadow a medical intern and see for yourself the difference in training.


Being a person who belives in science and the scientific method---I have learned not to accept sweeping broad generalizations because they tend to be flawed. Podiatrists, Dentists, and Optometrists all prescribe systemic drugs within a limited formulary designated by their scope of practice. This is done safely in most cases (just as medical physicians do within a broader scope.) The eye doctor (Doctor of Optometry) I work with writes oral scripts on a regular basis being affiliated with the local Eye Institute he treats a lot of primary eye disease by way of medical management. He completed a 1 year residency after Optometry school which focused on medical management of eye disease (this includes management of systemic conditions that affect the ocular system.) This is 5 years total to treat safely within a limited scope of practice--the ocular system and associated systemic conditions. Your "medical education" example is sooo tired and overstated because it is flawed. Why is it flawed? because you are making assumptions throughout it-----example, "Would an OD know to ask a pt if they were on an ACE-I prior to starting an NSAID?---the answer to this question after asking two OD's I work with is ABSOLUTELY! I will start attending Optometry school next year so I will concede to the wealth of medical knowledge you MUST have BUT I have taken statistics and quite a few graduate level science courses and must offer some advice to you.....You need facts---not assumptions.....Did you survey a representative sample of OD's and ask them, "Would an OD know to ask a pt if they were on an ACE-I prior to starting an NSAID?" You are an MD for god sakes----you understand the concept of "the burden of truth." You seem to be very intelligent but you lack respect for the optometric profession's training and abilities and in a way insulted every OD that I know who writes these evil systemic drugs on a regular basis safely----what gives man? :rolleyes:

ahhh, futuredoctorOD, i forgot about you! how i missed your posts! well, welcome back ;) how's your shadowing going? you must be very excited about becoming a genuine futuredoctorOD soon!

Well anyhooo....Cheers,

After reading these threads, I think it is scary that any health care professional that has not completed a medical internship, would prescribe systemic meds, like prednisone and/or abx.

Those that do this have absolutely no clue about all the serious adverse rxns that can happen. After completing 4 yrs of medical school training, I was still so unprepared to treat pts with systemic meds (even the so called benign ones) at the start of my internship year.

One can read an entire textbook about the adverse effects of certain meds but it really is not until you see these things that you can truly identify them.

Cushing's syndrome, secondary adrenal insuff, c-diff colitis, liver failure, renal failure, syncope, hemolytic anemia, heart failure, so on and so on. I have seen and treated these diseases, all of which were drug induced.

The privilege to rx systemic meds should not be taken so lightly. Giving a med even like NSAIDs can cause very severe problems (ie, ARF in the elderly).

Would an OD know to ask a pt if they were on an ACE-I prior to starting an NSAID?

Prednisone and certain abx can cause even worse problems. It is impossible to recognize these effects, when you have never seen it.

Also, what about all the other meds the pt is on? Would an OD know about the various interactions/contraindications when dealing with multiple other non ocular systemic meds?

Simply referring to the primary doc is a poor answer. The issue is to recognize the risks or the development of these adverse effects and choose the correct med or make the appropriate changes before the problem arises.

There is no question in my mind that an OMD is better qualified to rx systemic meds than an OD. If you do not agree, then I welcome you to shadow a medical intern and see for yourself the difference in training.
You'd better make sure you never visit the dentist, then. God only knows the horrors that may ensue.

You'd better make sure you never visit the dentist, then. God only knows the horrors that may ensue.

I don't believe Dentists will be using prednisone, but correct me if I'm wrong.
Antibiotics and some pain meds are all dentists have to worry about. I don't believe too many horrors will happen with antibiotics or the pain meds Dentists are allowed to use. :laugh:

I don't believe Dentists will be using prednisone, but correct me if I'm wrong.
Consider yourself corrected, then.

Antibiotics and some pain meds are all dentists have to worry about. I don't believe too many horrors will happen with antibiotics or the pain meds Dentists are allowed to use. :laugh:
I'd recommend double-checking your sources on this one.

Consider yourself corrected, then.


I'd recommend double-checking your sources on this one.
Give me an example that a dentist (not oral surgeon) would use prednisone, especially on a regular basis.

Correct me, then sir!

(not oral surgeon)
I wasn't thinking of oral surgeons, actually...but since you brought them up, are you suggesting they aren't dentists?

Give me an example that a dentist would use prednisone.
Pemphigus vulgaris, cicatricial pemphigoid, lichen planus, SLE, oral submucous fibrosis, Kaposi's, Sjogren's, candidiasis, oral surgery, the list goes on.

Look, I'm not here to start a pissing contest with anybody. You wanted some examples; I'm giving you some. If you're satisfied, that's great :thumbup: If you're not, go do the research yourself. I'm not going to waste time arguing an issue that's already conclusively settled.

Pemphigus vulgaris, cicatricial pemphigoid, lichen planus, SLE, oral submucous fibrosis, Kaposi's, Sjogren's, candidiasis, oral surgery, the list goes on.

Once again, thanks for educating us Bill! (genuinely stated, no sarcasm here)

Look, I'm not here to start a pissing contest with anybody.

This I find hard to believe given your track record on this forum.

Once again, thanks for educating us Bill! (genuinely stated, no sarcasm here)



This I find hard to believe given your track record on this forum.
I'll second that. Home-slice here spends more time on optom and ophtho forums than anywhere!

I wasn't thinking of oral surgeons, actually...but since you brought them up, are you suggesting they aren't dentists?


Pemphigus vulgaris, cicatricial pemphigoid, lichen planus, SLE, oral submucous fibrosis, Kaposi's, Sjogren's, candidiasis, oral surgery, the list goes on.



Look, I'm not here to start a pissing contest with anybody. You wanted some examples; I'm giving you some. If you're satisfied, that's great :thumbup: If you're not, go do the research yourself. I'm not going to waste time arguing an issue that's already conclusively settled.

They are dentists, but they have more extensive training in dealing with medications. 85% of them have a MD and of course, they have experience dealing with surgical patients, not minor dental procedures.

I'm sure dentists see this stuff everyday. (sarcasm) Anyway, if you were to see any of these problems, I hope you would refer to this your local family physician, especially Kaposi's :eek: .

Oh, and by the way, steroids (prednisone) cause candidiasis especially in the mouth (asthma meds). They would exacerbate the problem. Clotrimazole is what should be used. Maybe you should spend more time learning Pharmacology than contibuting "excessively" to a Doctor's forum.

Good luck to you in your wanna-be physician practice. :luck:

They are dentists, but they have more extensive training in dealing with medications. 85% of them have a MD and of course, they have experience dealing with surgical patients, not minor dental procedures.

I'm sure dentists see this stuff everyday. (sarcasm) Anyway, if you were to see any of these problems, I hope you would refer to this your local family physician, especially Kaposi's :eek: .

Oh, and by the way, steroids (prednisone) cause candidiasis especially in the mouth (asthma meds). They would exacerbate the problem. Clotrimazole is what should be used. Maybe you should spend more time learning Pharmacology than contibuting "excessively" to a Doctor's forum.

Good luck to you in your wanna-be physician practice. :luck:

Look, I don't know who you think you are making a teenage like comment about Bill's chosen field "Good luck to you in your wanna-be physician practice." but I regret to inform you that Denitsts are physicians There is NO equivalent medical specialty in Allopathy so if you feel comfortable going to a family practice MD to have your teeth worked on (because you feel that Doctors of Dental Surgery are poorly trained in medications) than go right ahead! Instead of asking Bill to review Pharmacology, instead why dont you read a book on how to address other professionals in a professional manner. Now I am 31 and I am guessing that you are 23 or 24----start acting like it. If you plan on being a doctor of Medicine (MD)---than you had better grow up. ;)

Look, I'm not here to start a pissing contest with anybody.

I smell piss. +pissed+

there is NO equivalent medical specialty in Allopathy so if you feel comfortable going to a family practice MD to have your teeth worked on than just say so! Instead of asking Bill to review Pharmacology, instead why dont you read a book on how to address other professionals in a professional manner.

You're right futuredocotrOD, there is no allopathic equivalent. But that's not what I2I said in his post. I believe he was implying that if a patient has Kaposi's sarcoma, they probably have a lot of other issues besides oropharyngeal (although very important) that need to be addressed...perhaps the patients underlying immune status, CD4 count, viral load, etc. Maybe we all need to do more reading :idea: !

ahhh, futuredoctorOD, i forgot about you! how i missed your posts! well, welcome back ;) how's your shadowing going? you must be very excited about becoming a genuine futuredoctorOD soon!

Well anyhooo....Cheers,


Hi there,

My shadowing is going great...I have seen many different ocular conditions thru the slit-lamp as an observer and I want to see more! I am in the application process soon and hope to get into at least 5-6 schools so I have a choice where to go....Research is another area of interest to me as is Pharmacology----I LOVE Pharmacology. I hope everything is going well with you and besh wishes..... ;)

Look, I don't know who you think you are making a teenage like comment about Bill's chosen field "Good luck to you in your wanna-be physician practice." but I regret to inform you that Denitsts are physicians There is NO equivalent medical specialty in Allopathy so if you feel comfortable going to a family practice MD to have your teeth worked on (because you feel that Doctors of Dental Surgery are poorly trained in medications) than go right ahead! Instead of asking Bill to review Pharmacology, instead why dont you read a book on how to address other professionals in a professional manner. Now I am 31 and I am guessing that you are 23 or 24----start acting like it. If you plan on being an effective doctor of Medicine (MD)---than you had better grow up. ;) :D

I smell piss. +pissed+



You're right futuredocotrOD, there is no allopathic equivalent. But that's not what I2I said in his post. I believe he was implying that if a patient has Kaposi's sarcoma, they probably have a lot of other issues besides oropharyngeal (although very important) that need to be addressed...perhaps the patients underlying immune status, CD4 count, viral load, etc. Maybe we all need to do more reading :idea: !


Having an opinion is one thing and devaluing an entire field of medicine (Dentistry) is something else. That was out of line..... :thumbdown

How are you doing?

Having an opinion is one thing and devaluing an entire field of medicine (Dentistry) is something else. That was out of line..... :thumbdown

How are you doing?

I'm fine...but ask me after a few weeks of wards as an intern. tx for asking, though.


You're right, but the blame shouldn't fall squarely on I2I's shoulders. Aphistis has a notorius history of coming onto this forum and interjecting in a condescending and confrontational manner. He's done it to me, he's done it to our moderators and he's doing it again. We're all mature adults and can handle it. But, FDrOD, since you are giving lectures on "being mature" today, how about this one? Bill, it's not what you say, it's how you say it. It's a free country and an open forum, but if you want to get your point across, i believe you are intelligent enough to do it in a way that doesn't incite "pissing contests." OTW, I think people on this forum have a hard time taking you seriously.

I don't believe too many horrors will happen with antibiotics or the pain meds Dentists are allowed to use. :laugh:

But horrors occur with the antibiotics and pain meds that physicians use? Same drugs, same scripts, same problems, if such problems do occur. The dispensing clinician isn't waived from dealing with ramifications of drugs they write for, simply on the basis of degree.

85% of them have a MD and of course, they have experience dealing with surgical patients, not minor dental procedures.


Closer to 40%. :)

They are dentists, but they have more extensive training in dealing with medications. 85% of them have a MD and of course, they have experience dealing with surgical patients, not minor dental procedures.

I'm sure dentists see this stuff everyday. (sarcasm) Anyway, if you were to see any of these problems, I hope you would refer to this your local family physician, especially Kaposi's :eek: .

Oh, and by the way, steroids (prednisone) cause candidiasis especially in the mouth (asthma meds). They would exacerbate the problem. Clotrimazole is what should be used. Maybe you should spend more time learning Pharmacology than contibuting "excessively" to a Doctor's forum.

Good luck to you in your wanna-be physician practice. :luck:
[shrug]

If you say so. I figured you've been spoiling for a fight this whole time, and like I said before, you'll have to fish somewhere else. I'm not going to argue with you about it.

This was posted in the optometry forum.

http://forums.studentdoctor.net/showthread.php?t=123623
http://www.revoptom.com/drugguide.asp?show=view&articleid=2

I find it rather disturbing when an article "teaches" optometrists how to prescribe medications like prednisone without much emphasis on the systemic side effects. :eek:

"Optometric physicians and their patients are enjoying the huge benefits of topically applied medications. Now it's time to fully embrace a different route of administration: the orally administered medicines. So that we can put this subset of drugs in perspective, realize that the internist must master hundreds of medicines; we only need to master a baker's dozen (give or take) to treat the vast majority of ophthalmic diseases."

The term optometric physicians appears again. Way to blur the lines even more! :rolleyes:


Dr. Doan,

With all due respect that article was meant to be just an informative piece---not a real clinical education on oral scripts! I think you took that article out of context.

Look, I don't know who you think you are making a teenage like comment about Bill's chosen field "Good luck to you in your wanna-be physician practice." but I regret to inform you that Denitsts are physicians There is NO equivalent medical specialty in Allopathy so if you feel comfortable going to a family practice MD to have your teeth worked on (because you feel that Doctors of Dental Surgery are poorly trained in medications) than go right ahead! Instead of asking Bill to review Pharmacology, instead why dont you read a book on how to address other professionals in a professional manner. Now I am 31 and I am guessing that you are 23 or 24----start acting like it. If you plan on being a doctor of Medicine (MD)---than you had better grow up. ;)

You need to read the begiining of the forum here...I asked what do Dentists use prednisone for...he mentioned candida, which steroids does not treat. There is no where you will find that Dentists are called physicians, PHYSICIANS ARE ONLY MDS. Many professionals call themselves Dr., thats fine I guess, I mean you can get a Phd in Botany and be called Dr., but only physicians=Medical degree. Get it straight ;)

I did not say anyone was poorly trained in medications, i don't think dentists should be treating a systemic disease (AIDS) that a PHYSICIAN was trained to treat.

The reason I said pseudo-physican is because he seems to want to treat medical conditions in a dental setting.

In no way did I imply that a family doctor start involving themselves in the care of teeth. :confused:

But horrors occur with the antibiotics and pain meds that physicians use? Same drugs, same scripts, same problems, if such problems do occur. The dispensing clinician isn't waived from dealing with ramifications of drugs they write for, simply on the basis of degree.

I agree, but used within dental context, they are not as much a problem.

Having an opinion is one thing and devaluing an entire field of medicine (Dentistry) is something else. That was out of line..... :thumbdown

How are you doing?


Denistry is not a field of medicine, IT IS DENISTRY. I did not devalue any specialty, but if you want to be a Doctor,then go to medical school, PLEASE. Everyone seems to want the same respect (and money)as physicians without going through the rigors and responsibilities of extensive medical training. It was not out of line, it was honest.

Denistry is not a field of medicine, IT IS DENISTRY. I did not devalue any specialty, but if you want to be a Doctor,then go to medical school, PLEASE. Everyone seems to want the same respect (and money)as physicians without going through the rigors and responsibilities of extensive medical training. It was not out of line, it was honest.

I just got off the phone with my brother who is SURGEON and he just remarked how he just came back from his eye doctor---his OPTOMETRIST and said that it will be really nice in 5 years when I graduate from OPTOMETRY School and become an eye doctor---the first one in the family. When I sprained my ankle----I went to my foot doctor---yep you guessed it ----my podiatrist---yes he is a doctor too! You really want to open this semantical pandoras box? Optometry school, Dental School, and Podiatry School are all extremely rigorous and making a blanket statement like you have is erroneous. The rigors of Medicine? How about the rigors of Dentistry? All these fields have similar RIGORS! :D lol Medicine is a very generalized term---all doctoral level professionals practice "medicine" in their own form and you need to just stop this semantical elitism. I have the utmost respect for MD's and DO's---my family has numerous iterations of the two degrees. Did you go to Dental School? or Optometry School? or Podiatry School? NO----you did not... :confused: You have no personal reference point to make a comparison....And by the way------IN THE HISTORICAL PAST THE TERM DOCTOR WAS USED ORIGINALY BY PHD'S NOT ALLOPATHY, OSTEOPATHY, CHIROPRACTIC, PODIATRY, OPTOMETRY, DENTISTRY, ETC....all these fields adopted the term doctor for the respect it carried....Allopathic medicine has done a very good job of marketing it's business over the last century and I have to give them credit for it...but the minute you try to say, incorrectly I might add, that DDS's, OD's, and DPM's are not doctors you appear to be very disrespectful to these specialists and to me----(I am working my ass off to get into a program and will continue that until I am an eye doctor and after that.) It is people like you that create the Oklahoma's (in regard to OD surgery) because of your elitist attitude...Now I respect your academic accomplishment but let's get real here and accept the fact that Dentistry is a field of medicine that is totally independent of your field.......Your field is NOT medicine in the generic--------it is ALLOPATHIC MEDICINE......You are an ALLOPATH---no more a doctor or less than a Dentist---(DOCTOR OF DENTAL SURGERY--DDS or DOCTOR OF DENTAL MEDICINE---DMD) I do respect your opinion and training.


PS---I checked----less than 40% of Oral Surgeons have MD's most of them only carry the OMFS designation---that must be soooooooooo scary to all those patients that are in danger because they don't have MD's We had better call the morgue and get all the slabs ready! :rolleyes:

I :love: Optometry and Ophthalmology

:cool: I just got off the phone with my cousin who is in OPTOMETRY school and he just remarked how difficult it was and how he can't imagine going through what we go through in an allopathic medical school! :laugh: Sorry man, I just can't ever resist repsonding to your posts because you are such an easy target on this forum.

In all seriousness, there is truth in much of what you've said (though to be fair, OK has a lot to do with greed on both sides: OD and OMD). But like I've told you before (and yes, this is unsolcited advice), keep shadowing and studying and working hard. Get into the best OD program you can and become the most awesome OD you can. Have your patients call you doctor and be proud that you are helping people see in this world. :luck: It's a great feeling to "do good for a living." And....if someone wants to run their mouth on this forum, just let them. Yeah, it's an open forum, but it's also an MD/DO forum, as long as they are not posting their opinions on an OD forum, what does it really matter to you at your stage of the game? Say what you have to say with intelligence and try not to incite riots by telling people that "they have some serious issues" or accusing what they are saying as having a "total lack of respect for an entire field." It just won't get you that far here and it's nauseating for those of us who really want to see this forum return to its original roots "Med students interested in ophthalmology trying to get info from residents etc on what the specialty is like, what programs are good, etc, and educational posts on pathology, etc." Do you really want to stand in the way of this? But then again, I am not a moderator, it's just one blogger's opinion.


I :love: Optometry and Ophthalmology

I do too!

Optometry school, Dental School, and Podiatry School are all extremely rigorous and making a blanket statement like you have is erroneous. The rigors of Medicine? How about the rigors of Dentistry? All these fields have similar RIGORS!

Gaining an OD degree may require rigors, but it doesn't require anywhere near the rigors that gaining an MD does. You graduate training is literally half as long as that of ophthalmologist's, and less time intensive during that period! Given that fact, it's not surprising that a lot of MD's are going to be pissed and look down at OD's who try to invade the MD's turf.

I just got off the phone with my brother who is SURGEON and he just remarked how he just came back from his eye doctor---his OPTOMETRIST and said that it will be really nice in 5 years when I graduate from OPTOMETRY School and become an eye doctor---the first one in the family. When I sprained my ankle----I went to my foot doctor---yep you guessed it ----my podiatrist---yes he is a doctor too! You really want to open this semantical pandoras box? Optometry school, Dental School, and Podiatry School are all extremely rigorous and making a blanket statement like you have is erroneous. The rigors of Medicine? How about the rigors of Dentistry? All these fields have similar RIGORS! :D lol Medicine is a very generalized term---all doctoral level professionals practice "medicine" in their own form and you need to just stop this semantical elitism. I have the utmost respect for MD's and DO's---my family has numerous iterations of the two degrees. Did you go to Dental School? or Optometry School? or Podiatry School? NO----you did not... :confused: You have no personal reference point to make a comparison....And by the way------IN THE HISTORICAL PAST THE TERM DOCTOR WAS USED ORIGINALY BY PHD'S NOT ALLOPATHY, OSTEOPATHY, CHIROPRACTIC, PODIATRY, OPTOMETRY, DENTISTRY, ETC....all these fields adopted the term doctor for the respect it carried....Allopathic medicine has done a very good job of marketing it's business over the last century and I have to give them credit for it...but the minute you try to say, incorrectly I might add, that DDS's, OD's, and DPM's are not doctors you appear to be very disrespectful to these specialists and to me----(I am working my ass off to get into a program and will continue that until I am an eye doctor and after that.) It is people like you that create the Oklahoma's (in regard to OD surgery) because of your elitist attitude...Now I respect your academic accomplishment but let's get real here and accept the fact that Dentistry is a field of medicine that is totally independent of your field.......Your field is NOT medicine in the generic--------it is ALLOPATHIC MEDICINE......You are an ALLOPATH---no more a doctor or less than a Dentist---(DOCTOR OF DENTAL SURGERY--DDS or DOCTOR OF DENTAL MEDICINE---DMD) I do respect your opinion and training.


PS---I checked----less than 40% of Oral Surgeons have MD's most of them only carry the OMFS designation---that must be soooooooooo scary to all those patients that are in danger because they don't have MD's We had better call the morgue and get all the slabs ready! :rolleyes:

I :love: Optometry and Ophthalmology
What planet are you from? When a child says I want to grow up to be a doctor, everyone (the public, parents, etc.) knows what they mean--a physician (MD). A child does not say I want to grow up to be an allopathic doctor.

I don't care who calls themselves doctor, but why don't you just be proud to be called an "optometrist". Whats wrong with that, seriously.
Everyone knows that people don't feel optometrists are real doctors...unless you lie and present yourself as one (fraud). If you don't believe me, ask them. They know MD/DO don't work at Walmart/Costco. Your relatives say your are because...their your relatives. :D

You believe we are called doctors because doctors (allopathic, for you) have done a good job marketing. I DONT THINK SO. Maybe its because, any moron can see they SAVE lives and people respect physicians especially when their lives are in danger. NO OTHER TYPE OF "DOCTOR" SAVES LIVES!

You say that I have no point of comparison-you have'nt even been to optometry school, what point do you have to comment on anyones schooling.
We have more education as a whole than any "doctor", so don't give me this bull**** about how hard you have it or will(which you don' t know, you only heard about). IT IS 7 YEARS MINIMUM FOR ANY MEDICAL SPECIALTY.


Its not people like me why ODs what to do surgery...The reasons are because they what to make more money (greedy), want to confuse the patients of want a real doctor is (MD vs, OD), don't want to have proper training (8 years min.), and would rather destroy someones eye for the sake of being called a real doctor (pride).

If you are looking for a fight, you will get one.....stop trolling! :mad:

Next time mind your own business. I'm Out.

I don't care who calls themselves doctor, but why don't you just be proud to be called an "optometrist". Whats wrong with that, seriously.
Everyone knows that people don't feel optometrists are real doctors...unless you lie and present yourself as one (fraud). If you don't believe me, ask them. They know MD/DO don't work at Walmart/Costco. Your relatives say your are because...their your relatives. :D
I didn't want to jump in here, but you forced me to. For your information the definition of:

MD = Doctor of Medicine
OD = Doctor of Optometry

You may choose to think we are not "real" doctors, but I can tell you that even patients at Wal-Mart know they are seeing a doctor.

Its not people like me why ODs what to do surgery...The reasons are because they what to make more money (greedy), want to confuse the patients of want a real doctor is (MD vs, OD), don't want to have proper training (8 years min.), and would rather destroy someones eye for the sake of being called a real doctor (pride).
There are many reasons why some OD's are pushing for expanded scope and I can assure you that none of them include greed, confusing patients, or pride. If you would actually have a discussion with one of the OD's on this forum rather than continue to state how much education you've had, how much harder it is to get into med school, or how much respect you deserve you might understand the real issues.

I didn't want to jump in here, but you forced me to. For your information the definition of:

MD = Doctor of Medicine
OD = Doctor of Optometry

You may choose to think we are not "real" doctors, but I can tell you that even patients at Wal-Mart know they are seeing a doctor.

Technically, you are completely correct. However, the term "doctor" has been used frequently for more then a century to refer to doctors of medicine. That is the connotation that the word has. While it's true that the term's dictionary definition is different, many laymen still use the term "doctor" to refer to MD's. Many ophthalmologists feel that some optometrists have been exploiting the confusion and not being forthright to their patients and the public about the differences b/w their training and an MD's training.



There are many reasons why some OD's are pushing for expanded scope and I can assure you that none of them include greed,

Oh please, now you're embarrasing yourself. Do you honestly believe that if there was no increased income potential linked to an expanded scope, that optometrists would still be pushing for an expanded scope in 1/10th as strong a manner? If so, then you're very naive. The optometrists are putting a lot of time, energy, and $$$ into their pushes for scope expansion. It's not just b/c they are a large group of amazing philanthropists who are really that desperate to be able to provide more care. This is about control of the field and cash.



confusing patients, or pride. If you would actually have a discussion with one of the OD's on this forum rather than continue to state how much education you've had, how much harder it is to get into med school, or how much respect you deserve you might understand the real issues.

I agree that we need to try and be more civil. But keep in mind that most people in med school went through enormous amounts of work and stress just to get in, let alone graduate. Then most MD graduates applying for ophthalmology had to again be super competitive and go through enormous amounts of stress just to get in, let alone finish internship, residency, etc. So when optometrists (who like it or not, have not had to under go nearly as much stress and work) begin to brush off our educations, it REALLY PUSHES OUR BUTTONS, and it's guaranteed to provoke lots of nasty remarks from the ophtho people. So if you optometrists want to argue that your training is sufficient to do a certain procedure (or rx, etc) please don't do so in a way that makes it look like the opthalmologists were just wasting our time and lives by going through all that sh*t.

Technically, you are completely correct. However, the term "doctor" has been used frequently for more then a century to refer to doctors of medicine. That is the connotation that the word has. While it's true that the term's dictionary definition is different, many laymen still use the term "doctor" to refer to MD's. Many ophthalmologists feel that some optometrists have been exploiting the confusion and not being forthright to their patients and the public about the differences b/w their training and an MD's training.So I guess dentists, podiatrists, etc are not doctors. As for OD's exploiting the confusion, you will need to provide some examples. How about this one. Aren't OMD's exploiting the confusion by prescribing eyeglasses. I mean, do most OMD's really know anything about eyeglasses other than their optical can be profitable?Oh please, now you're embarrasing yourself. Do you honestly believe that if there was no increased income potential linked to an expanded scope, that optometrists would still be pushing for an expanded scope in 1/10th as strong a manner? If so, then you're very naive. The optometrists are putting a lot of time, energy, and $$$ into their pushes for scope expansion. It's not just b/c they are a large group of amazing philanthropists who are really that desperate to be able to provide more care. This is about control of the field and cash.
I don't know how many times I have to explain this. Expanded scope does not make OD's a lot of money. I know this because I am actually in practice. Where do you think the income potential is in prescibing oral antibiotics? Where is the income potential in prescibing oral steroids? Where is the income potential of performing one or two YAG's per month at $128 each (that won't cover the lease payment). The issue has nothing to do with money. The majority of OD's want to expand their scope of practice to be able to provide care to their patients without having to refer cases that they can manage. This makes health care delivery more convenient for patients and less expensive. Yes, there are some fringe OD's that believe we should be doing surgery, and as usual they seem to be the ones that get the most publicity. These are fringe ideas. Just like the fringe OMD's that think OD's should not be able to recommend OTC artificial tears (California), treat glaucoma (New York), insert punctal plugs (Washington), etc.

If you want to really talk about cash, let's talk about OMD's owning opticals. Granted, we are not talking life or death, but why do OMD's need to sell glasses? It certainly isn't because they are group of amazing philanthropists.
I agree that we need to try and be more civil. But keep in mind that most people in med school went through enormous amounts of work and stress just to get in, let alone graduate. Then most MD graduates applying for ophthalmology had to again be super competitive and go through enormous amounts of stress just to get in, let alone finish internship, residency, etc. So when optometrists (who like it or not, have not had to under go nearly as much stress and work) begin to brush off our educations, it REALLY PUSHES OUR BUTTONS, and it's guaranteed to provoke lots of nasty remarks from the ophtho people. So if you optometrists want to argue that your training is sufficient to do a certain procedure (or rx, etc) please don't do so in a way that makes it look like the opthalmologists were just wasting our time and lives by going through all that sh*t.
I am not arguing that our training is the same. What I will say is that in every state that there has been expanded scope, there has not been any evidence presented that patients have been harmed. This includes OK. That is why there has never been a state to permanently reverse an expanded scope bill.

If you are looking for a fight, you will get one.....stop trolling! :mad:

Next time mind your own business. I'm Out.

2 questions:

1. to the OMDs: why does it matter what Ben or futuredoctorOD or any other non-OMDs on this forum think? I thought andrew doan and many others had great solutions to this ophtho vs. opto debate: "draw the line at surgey," get involved at the level of the AAO and our state and federal governments (letters, PAC contributions, etc) and protect our field. Same old arguments? yes, but some great soutions to the problem are very accomplishable. arguing about how prestigious an MD is should be something that we inherently know, all i need to do is see the look at my patients' faces to not only know what a prestigious job i have, but also that all the "sh*t" i went through to get here was well worth it. i don't need to prove that to Ben or futuredoctorOD.

2. to the non-OMDs who frequent this forum: why do you like to come here anyway? i really am curious. are you not being satisfied by your own forums? honest question, no sarcasm. i've noticed that many of you enjoy coming to this MD/DO forum and lecturing us on "being professional" and stating over and over again that "the MD degree is not the only path to enlightenment, ODs are doctors too, etc, etc" I agree with you on these points, but I can not help but feel that many of you just like to come here and pick a fight. is it just me?

2. to the non-OMDs who frequent this forum: why do you like to come here anyway? i really am curious. are you not being satisfied by your own forums? honest question, no sarcasm. i've noticed that many of you enjoy coming to this MD/DO forum and lecturing us on "being professional" and stating over and over again that "the MD degree is not the only path to enlightenment, ODs are doctors too, etc, etc" I agree with you on these points, but I can not help but feel that many of you just like to come here and pick a fight. is it just me?

Ruben,

In all honesty, I come here because of threads with names like "Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!" and "Optometry and Prescriptions" and "Let's end the war..." and on an on. These are threads started by OMDs but specifically about the OD/OMD relations, and they can get negative about ODs. The ODs and students feel inclined to respond.

Why the dentists spend their time cruising these forums is a mystery to me still. Perhaps with no allopathic specialty overlapping their field, their forum is boring because there's no one to argue with?

As you know, Optometry and Ophthalmology occupy very overlapping territory, for the most part, and probably more so than any other two fields (if I can use that word anymore ;)). We're going to butt heads, we're going to argue. We do argue out in the real world, in state assemblies, and in D.C. We're just practicing here.

Why some people are so confrontational and denigrating to the other side while arguing is a big second mystery to me.

Tom Stickel
Indiana U. School of Optometry 2001

2 questions:

1. to the OMDs: why does it matter what Ben or futuredoctorOD or any other non-OMDs on this forum think? I thought andrew doan and many others had great solutions to this ophtho vs. opto debate: "draw the line at surgey," get involved at the level of the AAO and our state and federal governments (letters, PAC contributions, etc) and protect our field. Same old arguments? yes, but some great soutions to the problem are very accomplishable. arguing about how prestigious an MD is should be something that we inherently know, all i need to do is see the look at my patients' faces to not only know what a prestigious job i have, but also that all the "sh*t" i went through to get here was well worth it. i don't need to prove that to Ben or futuredoctorOD.

2. to the non-OMDs who frequent this forum: why do you like to come here anyway? i really am curious. are you not being satisfied by your own forums? honest question, no sarcasm. i've noticed that many of you enjoy coming to this MD/DO forum and lecturing us on "being professional" and stating over and over again that "the MD degree is not the only path to enlightenment, ODs are doctors too, etc, etc" I agree with you on these points, but I can not help but feel that many of you just like to come here and pick a fight. is it just me?

I first came to SDN because I used to be on the admissions committee of an optometry school and I was encouraged to sign up and I answered some private emails.

I found the ophthalmology forums because I was interested in some of the grand rounds cases that Dr. Doan put up, particularly the ones that had a "neuro" slant to them because I do a fair amount of vision therapy.

Like Dr. Stickel I too saw some of the thread names and began reading some of them. There were so many of them that were so filled with inaccuracies and shrill rehetoric about the optometric profession, optometrists themselves, and optometric education in particular. I was very hesitant to respond because I knew it would just degnerate the way that it did. I knew this because I used to work and teach in a VA hospital where I tought BOTH optometry students and ophthalmology residents as well as medical students rotating through and I learned very quickly that the most arrogant group of people you will ever meet in your life are first year residents. The 2nd most arrogant are 4th year medical students. Unfortunately, that's the population that makes up the bulk of these forums. For better or for worse, I responded trying to clear up some of the misconceptions and while I have had good responses and dialogue with Dr. Doan and mdkurt, most of it is just the same old crap rehashed again and again and again.

I've been practicing for almost 15 years now so I've been through the wars. I recall OMDs testifying in the state legislatures that optometrists would be blinding their patients with proparaciane or killing them with tropicamide if ODs were allowed to use these "very powerful and dangerous" drugs as one OMD referred to them. I recall a time when OMDs could be disciplined by their academy if they taught in a school of optometry. As I have documented on here many times, I've lived through the wars here in New York where OMD are constantly trying to repeal scope of practice legislation in a state that already has one of the most restricvite in the nation.

With respect to Dr. Chudners post, I don't agree that expanded scope isn't about money. Of course it is. It's not about greed, because as he points out the money to be made by doing YAGs and PIs is not enough to cover the lease or cost of a laser in an optometry office, even if a bunch of ODs banded together and started their own ASC. The money comes not from doing a few procedures, but from not having to refer patients out never to be seen again when ODs could have easily and competently provided the care themselves. Yes, keeping the patients in our offices keeps us busier and makes us more money. So in that sense, yes, it is about money.

I think futuredoctorOD should not post on this forum. He doesn't have much of a frame of reference since he's not even in optometry school yet. His only perspective seems to be working alongside of an OD who prescribed some oral medications a few times and for some reason seems more concerned about whether non physician providers should be referred to as "doctors" or not. That's hardly the biggest issue on this forum yet he continues to harp on it. I usually skip his posts.

Jenny

With respect to Dr. Chudners post, I don't agree that expanded scope isn't about money. Of course it is. It's not about greed, because as he points out the money to be made by doing YAGs and PIs is not enough to cover the lease or cost of a laser in an optometry office, even if a bunch of ODs banded together and started their own ASC. The money comes not from doing a few procedures, but from not having to refer patients out never to be seen again when ODs could have easily and competently provided the care themselves. Yes, keeping the patients in our offices keeps us busier and makes us more money. So in that sense, yes, it is about money.
I agree with this. In the the sense that we do not want to lose our patients to OMD's that provide primary care, yes it is about money. I should have said, it has nothing to do with greed, but I was a little fired up. Thanks for the clarification.

2. to the non-OMDs who frequent this forum: why do you like to come here anyway? i really am curious. are you not being satisfied by your own forums? honest question, no sarcasm. i've noticed that many of you enjoy coming to this MD/DO forum and lecturing us on "being professional" and stating over and over again that "the MD degree is not the only path to enlightenment, ODs are doctors too, etc, etc" I agree with you on these points, but I can not help but feel that many of you just like to come here and pick a fight. is it just me?
Ruben, I cannot speak for the other OD's, but I have no intention of picking fights. I do, however, feel obligated to respond to certain posts.

I came across this forum, much like Jenny did. I speak to OD students for one of the contact lens companies, and I was interested in what they think are important issues. While scrolling down the main forum page I found the OMD forum and took a look. What I found was very different from the OD forum in that the thread titles were very inflammatory. My favorite was the "Optometrist are a joke, not a threat" thread. I believe the forum is at its best when opposing sides can discuss these issues rather than have one side simply voicing their approval of the thread. I agree, sometimes we get a little testy, but that shows we are passionate about the subject. I hope my posts have not come off as rude, because that is not my intention.

Okay, I have a better understanding now. Thanks for your replies.



Why some people are so confrontational and denigrating to the other side while arguing is a big second mystery to me.


me too.

I used to work and teach in a VA hospital where I tought BOTH optometry students and ophthalmology residents as well as medical students rotating through and I learned very quickly that the most arrogant group of people you will ever meet in your life are first year residents. The 2nd most arrogant are 4th year medical students.

i find it unfortunate that we have jaded you. but, you don't know me and i think there a lot of down-to-earth eye doctors of the allopathic persuasion who post on this forum.

I found the ophthalmology forums because I was interested in some of the grand rounds cases that Dr. Doan put up, particularly the ones that had a "neuro" slant to them because I do a fair amount of vision therapy.

that's great! I think this along with ophtho residency matching advice
is what draws most people to this forum. i would really like to see more energy put into those 2 issues.

For better or for worse, I responded trying to clear up some of the misconceptions .

all in all, for better. i enjoy reading what you post for the most part. i also hope futuredoctorOD will contribute meaningful contributions to this forum when he is a little further along. that being said, i still have quite a way to go myself.

I believe the forum is at its best when opposing sides can discuss these issues rather than have one side simply voicing their approval of the thread.

me too and i hope we can continue. perhaps we should adopt jenny's policy of ignoring posts from certain individuals (OD and OMDs, past, present and future). but then again, what do I know?

I hope my posts have not come off as rude, because that is not my intention.

you're not the only one guilty of this, i think we can all (OMDs especially included) do a better job with this.

thanks for answering my questions. happy posting! +pad+

I first came to SDN because I used to be on the admissions committee of an optometry school and I was encouraged to sign up and I answered some private emails.

I found the ophthalmology forums because I was interested in some of the grand rounds cases that Dr. Doan put up, particularly the ones that had a "neuro" slant to them because I do a fair amount of vision therapy.

Like Dr. Stickel I too saw some of the thread names and began reading some of them. There were so many of them that were so filled with inaccuracies and shrill rehetoric about the optometric profession, optometrists themselves, and optometric education in particular. I was very hesitant to respond because I knew it would just degnerate the way that it did. I knew this because I used to work and teach in a VA hospital where I tought BOTH optometry students and ophthalmology residents as well as medical students rotating through and I learned very quickly that the most arrogant group of people you will ever meet in your life are first year residents. The 2nd most arrogant are 4th year medical students. Unfortunately, that's the population that makes up the bulk of these forums. For better or for worse, I responded trying to clear up some of the misconceptions and while I have had good responses and dialogue with Dr. Doan and mdkurt, most of it is just the same old crap rehashed again and again and again.

I've been practicing for almost 15 years now so I've been through the wars. I recall OMDs testifying in the state legislatures that optometrists would be blinding their patients with proparaciane or killing them with tropicamide if ODs were allowed to use these "very powerful and dangerous" drugs as one OMD referred to them. I recall a time when OMDs could be disciplined by their academy if they taught in a school of optometry. As I have documented on here many times, I've lived through the wars here in New York where OMD are constantly trying to repeal scope of practice legislation in a state that already has one of the most restricvite in the nation.

With respect to Dr. Chudners post, I don't agree that expanded scope isn't about money. Of course it is. It's not about greed, because as he points out the money to be made by doing YAGs and PIs is not enough to cover the lease or cost of a laser in an optometry office, even if a bunch of ODs banded together and started their own ASC. The money comes not from doing a few procedures, but from not having to refer patients out never to be seen again when ODs could have easily and competently provided the care themselves. Yes, keeping the patients in our offices keeps us busier and makes us more money. So in that sense, yes, it is about money.

I think futuredoctorOD should not post on this forum. He doesn't have much of a frame of reference since he's not even in optometry school yet. His only perspective seems to be working alongside of an OD who prescribed some oral medications a few times and for some reason seems more concerned about whether non physician providers should be referred to as "doctors" or not. That's hardly the biggest issue on this forum yet he continues to harp on it. I usually skip his posts.

Jenny

With all due respect I have to I have to disagree with you. I have been immersed in medicine my entire life in one way shape or form. You do not know my background so why do you make a generalization? I spend 99% of my time devoted to my pre-optometry duties but I have a passion for debate and know where I am going in my life. Again you are incorrect as to my "only" interest being the debate over semantics (physcian versus non-physician, doctor...etc.) I am actually more concerned about --99% getting in a Program!!!! After this I am concerned about OD's having a uniform scope of practice nationwide, having all the tools necessary (formulary and procedures) to perform primary eye care, and improving 3rd party pay plans and other insurance matters. If you knew anything about my background you would understand but that is my personal business and not yours. This ophthalmology forum is a wonderful forum and interests me tremedously--I am much more interested in spending the spare moments I have in this forum or even the opto forum debating "real life" issues than emailing back and forth with 22 year olds (all due respect to them) about things I am well aware of because I want to gather knowledge about opthalmic health, political issues, etc. If you skip my posts, that is fine. I read whatever I get my hands on!
I will make a difference in Optometry down the road---this I promise you. ;)

Okay, I have a better understanding now. Thanks for your replies.



me too.



i find it unfortunate that we have jaded you. but, you don't know me and i think there a lot of down-to-earth eye doctors of the allopathic persuasion who post on this forum.



that's great! I think this along with ophtho residency matching advice
is what draws most people to this forum. i would really like to see more energy put into those 2 issues.



all in all, for better. i enjoy reading what you post for the most part. i also hope futuredoctorOD will contribute meaningful contributions to this forum when he is a little further along. that being said, i still have quite a way to go myself.



me too and i hope we can continue. perhaps we should adopt jenny's policy of ignoring posts from certain individuals (OD and OMDs, past, present and future). but then again, what do I know?



you're not the only one guilty of this, i think we can all (OMDs especially included) do a better job with this.

thanks for answering my questions. happy posting! +pad+


You are the best moderator on here! :thumbup:

With all due respect I have to I have to disagree with you. I have been immersed in medicine my entire life in one way shape or form. You do not know my background so why do you make a generalization? I spend 99% of my time devoted to my pre-optometry duties but I have a passion for debate and know where I am going in my life. Again you are incorrect as to my "only" interest being the debate over semantics (physcian versus non-physician, doctor...etc.) I am actually more concerned about --99% getting in a Program!!!! After this I am concerned about OD's having a uniform scope of practice nationwide, having all the tools necessary (formulary and procedures) to perform primary eye care, and improving 3rd party pay plans and other insurance matters. If you knew anything about my background you would understand but that is my personal business and not yours. This ophthalmology forum is a wonderful forum and interests me tremedously--I am much more interested in spending the spare moments I have in this forum or even the opto forum debating "real life" issues than emailing back and forth with 22 year olds (all due respect to them) about things I am well aware of because I want to gather knowledge about opthalmic health, political issues, etc. If you skip my posts, that is fine. I read whatever I get my hands on!
I will make a difference in Optometry down the road---this I promise you. ;) :D

With all due respect I have to I have to disagree with you. I have been immersed in medicine my entire life in one way shape or form. You do not know my background so why do you make a generalization? I spend 99% of my time devoted to my pre-optometry duties but I have a passion for debate and know where I am going in my life. Again you are incorrect as to my "only" interest being the debate over semantics (physcian versus non-physician, doctor...etc.) I am actually more concerned about --99% getting in a Program!!!! After this I am concerned about OD's having a uniform scope of practice nationwide, having all the tools necessary (formulary and procedures) to perform primary eye care, and improving 3rd party pay plans and other insurance matters. If you knew anything about my background you would understand but that is my personal business and not yours. This ophthalmology forum is a wonderful forum and interests me tremedously--I am much more interested in spending the spare moments I have in this forum or even the opto forum debating "real life" issues than emailing back and forth with 22 year olds (all due respect to them) about things I am well aware of because I want to gather knowledge about opthalmic health, political issues, etc. If you skip my posts, that is fine. I read whatever I get my hands on!
I will make a difference in Optometry down the road---this I promise you. ;)

You can correct me if I'm wrong, but my impression from reading your posts is that your "immersion" in medicine seems to be having some relatives who are MDs. I would say that that is hardly "immersion." Given that, and the fact that you are not even enrolled in optometry school and your only experience in optometry seems to be having shadowed and/or worked for an OD, (again, correct me if I'm wrong) I would suggest that you don't have the experience or in depth knowledge of the issues facing the profession to comment on them. Even if you did, I don't think you have an adequate frame of reference in which to have a reasonable debate.

I'm sure you'll be a credit to the profession one day. Until you are at least enrolled in school, you are probably doing more harm than trying to debate OMDs. When I used to read your posts, I would cringe.

I just got off the phone with my brother who is SURGEON and he just remarked how he just came back from his eye doctor---his OPTOMETRIST and said that it will be really nice in 5 years when I graduate from OPTOMETRY School and become an eye doctor---the first one in the family. When I sprained my ankle----I went to my foot doctor---yep you guessed it ----my podiatrist---yes he is a doctor too! You really want to open this semantical pandoras box? Optometry school, Dental School, and Podiatry School are all extremely rigorous and making a blanket statement like you have is erroneous. The rigors of Medicine? How about the rigors of Dentistry? All these fields have similar RIGORS! :D lol Medicine is a very generalized term---all doctoral level professionals practice "medicine" in their own form and you need to just stop this semantical elitism. I have the utmost respect for MD's and DO's---my family has numerous iterations of the two degrees. Did you go to Dental School? or Optometry School? or Podiatry School? NO----you did not... :confused: You have no personal reference point to make a comparison....And by the way------IN THE HISTORICAL PAST THE TERM DOCTOR WAS USED ORIGINALY BY PHD'S NOT ALLOPATHY, OSTEOPATHY, CHIROPRACTIC, PODIATRY, OPTOMETRY, DENTISTRY, ETC....all these fields adopted the term doctor for the respect it carried....Allopathic medicine has done a very good job of marketing it's business over the last century and I have to give them credit for it...but the minute you try to say, incorrectly I might add, that DDS's, OD's, and DPM's are not doctors you appear to be very disrespectful to these specialists and to me----(I am working my ass off to get into a program and will continue that until I am an eye doctor and after that.) It is people like you that create the Oklahoma's (in regard to OD surgery) because of your elitist attitude...Now I respect your academic accomplishment but let's get real here and accept the fact that Dentistry is a field of medicine that is totally independent of your field.......Your field is NOT medicine in the generic--------it is ALLOPATHIC MEDICINE......You are an ALLOPATH---no more a doctor or less than a Dentist---(DOCTOR OF DENTAL SURGERY--DDS or DOCTOR OF DENTAL MEDICINE---DMD) I do respect your opinion and training.


PS---I checked----less than 40% of Oral Surgeons have MD's most of them only carry the OMFS designation---that must be soooooooooo scary to all those patients that are in danger because they don't have MD's We had better call the morgue and get all the slabs ready! :rolleyes:

I :love: Optometry and Ophthalmology

Is this a "professional" exchange? I would be upset about the "doctor" part if I were you, too (but still question "optometric physician").

Please explain further your perspective on "elitism" by MD's causing the Oklahoma situation (political pro-surgery maneuver by OD's).

What planet are you from? When a child says I want to grow up to be a doctor, everyone (the public, parents, etc.) knows what they mean--a physician (MD). A child does not say I want to grow up to be an allopathic doctor.

I don't care who calls themselves doctor, but why don't you just be proud to be called an "optometrist". Whats wrong with that, seriously.
Everyone knows that people don't feel optometrists are real doctors...unless you lie and present yourself as one (fraud). If you don't believe me, ask them. They know MD/DO don't work at Walmart/Costco. Your relatives say your are because...their your relatives. :D

You believe we are called doctors because doctors (allopathic, for you) have done a good job marketing. I DONT THINK SO. Maybe its because, any moron can see they SAVE lives and people respect physicians especially when their lives are in danger. NO OTHER TYPE OF "DOCTOR" SAVES LIVES!

You say that I have no point of comparison-you have'nt even been to optometry school, what point do you have to comment on anyones schooling.
We have more education as a whole than any "doctor", so don't give me this bull**** about how hard you have it or will(which you don' t know, you only heard about). IT IS 7 YEARS MINIMUM FOR ANY MEDICAL SPECIALTY.


Its not people like me why ODs what to do surgery...The reasons are because they what to make more money (greedy), want to confuse the patients of want a real doctor is (MD vs, OD), don't want to have proper training (8 years min.), and would rather destroy someones eye for the sake of being called a real doctor (pride).

If you are looking for a fight, you will get one.....stop trolling! :mad:

Next time mind your own business. I'm Out.

You must be a medical student. Just stop it. You are making the rest of us look bad. They are doctors. period. If you said physicians, that would be different.

You must be a medical student. Just stop it. You are making the rest of us look bad. They are doctors. period. If you said physicians, that would be different.


You need to read the whole thread. FuturedocOD did say that Dentists and optometrists are physicians.

Sorry to make you look bad...they're trying to make us look bad.
If you don't like it, don't read this thread. Thanks. :o

Is this a "professional" exchange? I would be upset about the "doctor" part if I were you, too (but still question "optometric physician").

Please explain further your perspective on "elitism" by MD's causing the Oklahoma situation (political pro-surgery maneuver by OD's).


First I will say that I appreciate your being civil with me on here and will gladly answer your question Dr. For many years, especially since 1972---the first year optometrists pursued having prescription rights for medications (it took 25 years of legal battlest to accomplish this in every state) , optometry has fought with medicine to attain **fundemental** privilages to practice and treat as primary eye doctors. The list of "battles" is too long and numerous to list, Jenny would know because she has been in practice for 15 years and has commented on the subject before. Collectively, wouldn't you think that any field after being in battle for sooo long with allopathy would not take every opportunity to improve it's position?-----case in point in Oklahoma. We are all human biengs and have flaws as a result....emotions and spite can motivate people and "health professionals" alike. I know that if I was confronted with practitioners with the attitude that I2I has, I would not listent to his opinion or ideas because he has an elitist and allopathic-centric (I made up this word..lol) attitude. No one is doubting that the doctor of ophthalmology is the ultimate expert-----because he/she is BUT semantics are important and when someone with a contrite attitude tries to question the fact that Optometrists ARE doctors.....I feel compelled to respond--even though I have not accomplished my goals of being accepted to a program, earning my OD degree, and doing a 1 year residency in ocular disease ( ie--like the one in Bascom Palmer or the Hunington VMAC.) As to the whole Optometric Physician thing, this is a term used in some states to assure insurance reimbursement......I think of doctor and physician as analagous terms.....Now medical doctor and or medical physician which only allopaths and osteopaths can use are independent of any other profession.

You need to read the whole thread. FuturedocOD did say that Dentists and optometrists are physicians.

Sorry to make you look bad...they're trying to make us look bad.
If you don't like it, don't read this thread. Thanks. :o


With all due respect I use the term physician and doctor interchangeably. This is not meant in disrespect.

What planet are you from? When a child says I want to grow up to be a doctor, everyone (the public, parents, etc.) knows what they mean--a physician (MD). A child does not say I want to grow up to be an allopathic doctor.

I don't care who calls themselves doctor, but why don't you just be proud to be called an "optometrist". Whats wrong with that, seriously.
Everyone knows that people don't feel optometrists are real doctors...unless you lie and present yourself as one (fraud). If you don't believe me, ask them. They know MD/DO don't work at Walmart/Costco. Your relatives say your are because...their your relatives. :D

You believe we are called doctors because doctors (allopathic, for you) have done a good job marketing. I DONT THINK SO. Maybe its because, any moron can see they SAVE lives and people respect physicians especially when their lives are in danger. NO OTHER TYPE OF "DOCTOR" SAVES LIVES!

You say that I have no point of comparison-you have'nt even been to optometry school, what point do you have to comment on anyones schooling.
We have more education as a whole than any "doctor", so don't give me this bull**** about how hard you have it or will(which you don' t know, you only heard about). IT IS 7 YEARS MINIMUM FOR ANY MEDICAL SPECIALTY.


Its not people like me why ODs what to do surgery...The reasons are because they what to make more money (greedy), want to confuse the patients of want a real doctor is (MD vs, OD), don't want to have proper training (8 years min.), and would rather destroy someones eye for the sake of being called a real doctor (pride).

If you are looking for a fight, you will get one.....stop trolling! :mad:

Next time mind your own business. I'm Out.
That is interesting....So if an optometrist diagnosed a life-threatening illness (like a brain tumor) in its early stage---that is not saving someone's life? Screening for illness and attacking it before it gets out of hand can be crucial. Look I am not going to argue with you----the whole universe and probably every profession recognized the Doctor of Optometry as an Eye Doctor---so I am not going to argue with you!!!! I am going to rise above because I respect Ophthalmologists as the experts in eye care and Optometrists as the gatekeepers...I am not on here to fight with you.

With all due respect I use the term physician and doctor interchangeably. This is not meant in disrespect.

A PhD working on string theory is certainly a doctor but not a physician (likewise for other PhD's). I, personally, have always thought that only MD's/DO's were physicians. Ok, that's it, no more posts from me on this type of peripheral issue. :thumbup:

I don't know how many times I have to explain this. Expanded scope does not make OD's a lot of money. I know this because I am actually in practice. Where do you think the income potential is in prescibing oral antibiotics? Where is the income potential in prescibing oral steroids? Where is the income potential of performing one or two YAG's per month at $128 each (that won't cover the lease payment).

I don't understand how someone can keep living this lie. Of course expanded scope will make more money! BTW, YAG capsulotomies, which OD's are pushing for, pay a hell of a lot more then $128 bucks each. Medicaire pays over 800 bucks for one of them, which makes it one of the most profitable areas of ophthalmology (far more profitable then cataracts, which only reimburse about 600 something and require much more overhead). So the idea that pushing for expanded scope to do one of the most profitable procedures possible "won't make OD's money" is complete BS.

BTW, where did this notion that only one OD would use one YAG come from? Obviously, many OD's form larger groups, and then buying a yag would be incredibely profitable.

I don't understand how someone can keep living this lie. Of course expanded scope will make more money! BTW, YAG capsulotomies, which OD's are pushing for, pay a hell of a lot more then $128 bucks each. Medicaire pays over 800 bucks for one of them, which makes it one of the most profitable areas of ophthalmology (far more profitable then cataracts, which only reimburse about 600 something and require much more overhead). So the idea that pushing for expanded scope to do one of the most profitable procedures possible "won't make OD's money" is complete BS.

BTW, where did this notion that only one OD would use one YAG come from? Obviously, many OD's form larger groups, and then buying a yag would be incredibely profitable.

Wow.

DIE THREAD, DIE!!!!!!!

The power of Christ compels you!!
THE POWER OF CHRIST COMPELS YOU!!!

(sprinkles Holy water on evil thread!)

I don't understand how someone can keep living this lie. Of course expanded scope will make more money! BTW, YAG capsulotomies, which OD's are pushing for, pay a hell of a lot more then $128 bucks each. Medicaire pays over 800 bucks for one of them, which makes it one of the most profitable areas of ophthalmology (far more profitable then cataracts, which only reimburse about 600 something and require much more overhead). So the idea that pushing for expanded scope to do one of the most profitable procedures possible "won't make OD's money" is complete BS.

BTW, where did this notion that only one OD would use one YAG come from? Obviously, many OD's form larger groups, and then buying a yag would be incredibely profitable.

Can you explain then, this chart which comes from the AAO itself?

http://www.aao.org/news/release/20041103.cfm

It would appear that the reimbursement is $248.23 in 2005.

That would be for straight medicare. If a patient is enrolled in a medicare HMO, I would guess that the reimbursement would be a lot LESS than this.

Jenny

I don't understand how someone can keep living this lie. Of course expanded scope will make more money! BTW, YAG capsulotomies, which OD's are pushing for, pay a hell of a lot more then $128 bucks each. Medicaire pays over 800 bucks for one of them, which makes it one of the most profitable areas of ophthalmology (far more profitable then cataracts, which only reimburse about 600 something and require much more overhead).With the exception of refractive surgery of course. :laugh:

I agree, I wish this thread would die, but since it hasn't I looked up the latest reimbursments for my area:

66984 Catract Surgery - $674.14
66821 Yag Cap - $243.60

I must have looked at the wrong line when I saw $128, but even at $243, this is not a profitable procedure. I have a fairly busy OD practice and I only refer out about 3-5 YAG's per month. The local cataract doc does about 7 YAG's per week in between his 16 cataracts and he draws from 10 OD offices plus his own clinic. At $243, I would collect about $14,000 a year before expenses (at 5 every month). I make 3 times that with my digital camera taking fundus photos with far less expense. This is not a profitable procedure for OD's.
BTW, where did this notion that only one OD would use one YAG come from? Obviously, many OD's form larger groups, and then buying a yag would be incredibely profitable.Even if 5 docs got together and bought a laser and each did 5 per month we would each make only $14K. For that small amount we would have to deal with the headache of either moving the laser between the offices, renting a space to house it (more expense), or still referring to another office for the procedure.

Its possible that the YAGs pay $800 (as quoted by Sledge) if you include facility fees. Just a thought, I could be wrong and it might not make any difference, but I'm throwing it out there anyway

Its possible that the YAGs pay $800 (as quoted by Sledge) if you include facility fees. Just a thought, I could be wrong and it might not make any difference, but I'm throwing it out there anyway
The facility fee in my Medicare area (rest of Washington State) for Yag Cap is $226.23. So the total would be $469.83. Of course Medicare will not pay a facility fee for a Yag unless it is in a separate facility such as an ASC. For an Argon laser, Medicare will pay a facility fee even if it is within the doctor's office. Therefore, for OD's to double their money on Yag reimbursements they would have to open an ASC which in some states would require a CON. Those can cost up to $100,000 in legal fees depending on whether the local hospital and the other ASC's choose to fight it. Then of course there is the building costs, or at least the rent, staff, utilities, increased liability, etc. Lots of money to spend just to get an additional $14K a year ($28K total). ;)

Can you explain then, this chart which comes from the AAO itself?

http://www.aao.org/news/release/20041103.cfm

It would appear that the reimbursement is $248.23 in 2005.

That would be for straight medicare. If a patient is enrolled in a medicare HMO, I would guess that the reimbursement would be a lot LESS than this.

Jenny


Ophthalmology attendings I've worked with have told me that they get over 800 bucks for a yag cap before overhead. One attending went on for a fairly long time about yag cap reimbursment, and how there is a problem with a few dirt bag ophthalmologists putting in the old silicon lenses just so there is a higher chance of needing to do a yag. Perhaps the attendings meant over 800 dollars per patient (since many patients get both cataracts removed). However, it doesn't change the fact that they're an extremely profitable area of ophthalmology, and would almost certainly be a profitable procedure for many optometrists. Think about it, a cataract operation pays about 600 bucks, and takes much longer and has much more overhead. Whereas, a yag only takes 10 minutes without any overhead other then the cost of the machine. If you do 7 yags a week, by the end of the year you'd be making 170,000 dollars!

Ophthalmology attendings I've worked with have told me that they get over 800 bucks for a yag cap before overhead. One attending went on for a fairly long time about yag cap reimbursment, and how there is a problem with a few dirt bag ophthalmologists putting in the old silicon lenses just so there is a higher chance of needing to do a yag. Perhaps the attendings meant over 800 dollars per patient (since many patients get both cataracts removed). However, it doesn't change the fact that they're an extremely profitable area of ophthalmology, and would almost certainly be a profitable procedure for many optometrists. Think about it, a cataract operation pays about 600 bucks, and takes much longer and has much more overhead. Whereas, a yag only takes 10 minutes without any overhead other then the cost of the machine. If you do 7 yags a week, by the end of the year you'd be making 170,000 dollars!
7 yags at $243 per yag = $1701 per week
$1701 per week for 52 weeks = $88,452

That's assuming you can schedule 7 per week, every week. A typical OD practice does not see enough patients to generate 7 yags per week. I know several busy OMD practices that require outside referrals to generate 7 yags per week.

BTW, there is very little overhead associated with cataract surgery for the surgeon. Yes, there is the 90 days of post-op, but an uneventful cataract surgery may only require 3 post-op visits which are very short visits and can be placed in between normal appointment spots. The overhead comes from the surgery center which gets paid separately from the surgeon.

Ophthalmology attendings I've worked with have told me that they get over 800 bucks for a yag cap before overhead. One attending went on for a fairly long time about yag cap reimbursment, and how there is a problem with a few dirt bag ophthalmologists putting in the old silicon lenses just so there is a higher chance of needing to do a yag. Perhaps the attendings meant over 800 dollars per patient (since many patients get both cataracts removed). However, it doesn't change the fact that they're an extremely profitable area of ophthalmology, and would almost certainly be a profitable procedure for many optometrists. Think about it, a cataract operation pays about 600 bucks, and takes much longer and has much more overhead. Whereas, a yag only takes 10 minutes without any overhead other then the cost of the machine. If you do 7 yags a week, by the end of the year you'd be making 170,000 dollars!

Cmon, Sledge. Surely you can do better than "an attending told me" when discussing this issue.

Here is a link to the CMS website:

http://www.cms.hhs.gov/physicians/mpfsapp/step3.asp

Entering code 66821 and selecting "all modifiers" shows a range of reimbursements for this procedure. Most of them are in the low to mid 200s. The highest one that I see is $327. The lowest that I see is $199. Again, this is for straight medicare. If the patient has a medicare HMO, the reimbursement is likely to be a LOT lower.

There is no way that this is a profitable venture for optometrists. I worked full time in a busy VA hospital for almost 4 years. We had no full time ophthalmologists on staff. The residents would come in a few days a month to handle the surgical cases. All examinations were conducted by staff ODs and/or optometry interns including pre op examinations and all post op exams including one days.

We would see at best, 5 or 6 people a MONTH amongst ALL of us who would benefit from a YAG. And that's working in a facility made up of elderly people almost exclusively.

Now I'm in private practice. The number of patients I see who could benefit from a YAG is a small handful per year. Hardly worth the headache, even if I was to go in on a laser with a bunch of other ODs.

Jenny

:laugh: Wow.

DIE THREAD, DIE!!!!!!!

The power of Christ compels you!!
THE POWER OF CHRIST COMPELS YOU!!!

(sprinkles Holy water on evil thread!)

BTW, there is very little overhead associated with cataract surgery for the surgeon. Yes, there is the 90 days of post-op, but an uneventful cataract surgery may only require 3 post-op visits which are very short visits and can be placed in between normal appointment spots. The overhead comes from the surgery center which gets paid separately from the surgeon.

The overhead for cataracts is much more then for yag caps. Yes, there is the cost of the OR, anesthesia, tech's, equipment (more expensive then a yag laser), preop visit, post op visits, etc. What's the overhead for a yag? Cost of the machine, that's it!

Cmon, Sledge. Surely you can do better than "an attending told me" when discussing this issue.


Well, since these are attendings who do yags and deal with the billing aspects, I'll take their word for it. Perhaps they were exagerating the amount of money, but there is no denying that yags are one of the more profitable areas of ophthalmology. Any optometry group could probaby make a decent profit off of them since each laser lasts for some time. You can pay the machine off in one year, and after that it's just a straight up several hundred dollars profit off of each 10 minute laser. No potential for higher income? yeah right!



Now I'm in private practice. The number of patients I see who could benefit from a YAG is a small handful per year. Hardly worth the headache, even if I was to go in on a laser with a bunch of other ODs.

Jenny

Well, since the OD groups have been pushing for rights to do yags, I find it hard to believe that no OD's would want to do them. Why would you refer patients to an ophthalmologist for something an OD can do? Eventually OD's would buy yag lasers and that would be that.

Well, since these are attendings who do yags and deal with the billing aspects, I'll take their word for it. Perhaps they were exagerating the amount of money, but there is no denying that yags are one of the more profitable areas of ophthalmology. Any optometry group could probaby make a decent profit off of them since each laser lasts for some time. You can pay the machine off in one year, and after that it's just a straight up several hundred dollars profit off of each 10 minute laser. No potential for higher income? yeah right!




Well, since the OD groups have been pushing for rights to do yags, I find it hard to believe that no OD's would want to do them. Why would you refer patients to an ophthalmologist for something an OD can do? Eventually OD's would buy yag lasers and that would be that.

Sledge,

YAGs might be one of the most profitable areas of ophtalmology, but just because that may be the case doesn't mean it would be one of the most profitable areas of optometry.

I don't think you have a good handle on the average optometry practice or what goes on in one. Optometry practices do not have tremendous amounts of YAG patients running around that are in constant need of referral and ODs want to treat them. Even when I was at the VA, as I've already told you we were not overrun with YAG patients.

With the new intraocular lenses used today, we don't see many PCOs. At Iowa, we only see a handful of patients needing YAG capsulotomies per week.

I don't think YAGs are that lucrative. Surgeons make more money doing cataract surgeries. The surgeon fee is $600 for cataract surgery, but the patient also pays for ASC and other fees too. The total bill for cataract surgery is over $2000.

With the new intraocular lenses used today, we don't see many PCOs. At Iowa, we only see a handful of patients needing YAG capsulotomies per week.

I don't think YAGs are that lucrative. Surgeons make more money doing cataract surgeries. The surgeon fee is $600 for cataract surgery, but the patient also pays for ASC and other fees too. The total bill for cataract surgery is over $2000.
Which goes to my point about overhead for cataract surgery. The overhead for a cataract surgery is much higher for the ASC than the surgeon.
The overhead for cataracts is much more then for yag caps. Yes, there is the cost of the OR, anesthesia, tech's, equipment (more expensive then a yag laser), preop visit, post op visits, etc.
The OR, anesthesia, tech's, and equipment are overhead for the ASC or hospital, not the surgeon. As Dr. Doan stated, they get paid above and beyond the ~$600 the surgeon gets. As for the pre-op visits, the initial consultation is a billiable exam (if referred in rather than from the OMD's clinic population it pays more) and the A-scan is a billable procedure. Those are also above and beyond the $600. The post-op visits are covered by the $600, but with the skill of today's surgeons, these visits take up very little time and cost very little in the whole scheme of things.

OD's are pushing for YAG's because they believe they are qualified (right or wrong) and they would prefer to keep these patients in their clinic rather than potentially lose them to the OMD down the street that also provides routine eyecare.

Podiatrists, Dentists, and Optometrists all prescribe systemic drugs within a limited formulary designated by their scope of practice. :

Podiatrists and dentists have an unlimited license to prescribe medications. Not a limited formulary.

LCR

Podiatrists and dentists have an unlimited license to prescribe medications. Not a limited formulary.

LCR

And not ALL ODs can write for systemic meds... it's not allowed in the state of Florida and four other states.