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Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!

Discussion in 'Ophthalmology: Eye Physicians & Surgeons' started by Yogi Bear, Apr 28, 2004.

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Do you support Optometrists doing surgery?

  1. Absolutely No: MD/DO/medical student

    672 vote(s)
    57.3%
  2. Absolutely No: Optometrist/Optometry student

    33 vote(s)
    2.8%
  3. Absolutely No: All others

    120 vote(s)
    10.2%
  4. Yes w/ proper optometry "surgical fellowships": MD/DO/medical student

    101 vote(s)
    8.6%
  5. Yes w/ proper optometry "surgical fellowships": Optometrist/Optometry student

    96 vote(s)
    8.2%
  6. Yes w/ proper optometry "surgical fellowships": All others

    56 vote(s)
    4.8%
  7. Absolutely Yes: MD/DO/medical student

    12 vote(s)
    1.0%
  8. Absolutely Yes: Optometrist/Optometry student

    24 vote(s)
    2.0%
  9. Absolutely Yes: All others

    20 vote(s)
    1.7%
  10. Undecided

    39 vote(s)
    3.3%
  1. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!

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    I hope you didn't say all that in one breathe...

    Yes I am aware of everything that you have written. It gets discussed AD NAUSEUM in the pre-med and med school forums. And I've been reading them for years now on SDN.

    I never meant to disrespect optometry as a profession. My comments were aimed at the few who were making inappropriate comments about ophthalmology and/or osteopathic medicine.

    Either way, thanks for fighting the ignorance about DO's.
  2. qwopty99

    qwopty99 Veterinary Optometrist?

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    Someone is backpedaling cause he got Stevie on his case (you don't want to do that).

    You might feel this way now, but you were put on probation for a reason.

    Well anyways, I guess you understand what it means to go too far.
  3. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!

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    Hardly.

    I was put on probation b/c it was my 3rd infarction on SDN, 2 of which happened in a span of 48 hours while I was trying to defend ophthalmology and DO's in the optometry forum.

    Remember? You even made a thread whining about your infarction...:laugh:

    Btw, who's Stevie?
  4. qwopty99

    qwopty99 Veterinary Optometrist?

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    Quote me where I "whined" about my (sic) infarction.
  5. qwopty99

    qwopty99 Veterinary Optometrist?

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    If you can take a reasoned look at the thread, you'll see the tone of the thread can be summed up here:

  6. qwopty99

    qwopty99 Veterinary Optometrist?

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    BTW. You don't get probation for defending ophthalmology and DOs. You get probation for putting down ODs.


    You can take off your rose-colored glasses now.
  7. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!

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    Dude, let it go.

    Back to the main topic...
  8. qwopty99

    qwopty99 Veterinary Optometrist?

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    Fine. :thumbup:
  9. futuredoctorOD

    futuredoctorOD Senior Member

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    "I hope you didn't say all that in one breathe...

    Yes I am aware of everything that you have written. It gets discussed AD NAUSEUM in the pre-med and med school forums. And I've been reading them for years now on SDN.

    I never meant to disrespect optometry as a profession. My comments were aimed at the few who were making inappropriate comments about ophthalmology and/or osteopathic medicine.

    Either way, thanks for fighting the ignorance about DO's.
    __________________
    DOCTORSAIB
    Philadelphia College of Osteopathic Medicine
    Class of 2008 "



    Fair Enough DOCTORSAIB. :thumbup:

    Remember I have a close relative who is a DO--> I know a lot about your field.
  10. killbill2

    killbill2

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    Come down, dude.

    Don't you have a better thing to do (like studying) than spending time to write a long post to defend a person who is obviously mentally disturbed to say things like "O.Ds' are phoropter-monkies"?

    I was simply trying to make the point you made. It's ironic that a D.O. would malign optometric profession.

    Anyway, you are a better person than DOCTORSAIB. DOCTORSAIB insults your profession and you make a long speech to defend his.
  11. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    One of the complaints I hear often from optometry involves changing states. An FP moves from FL to NY and their scope of practice changes very little. An OD moves from SC to NJ and they lose the ability to do things that they actually were trained for. I don't know the extent, but I do know that OD schools do teach how to medically manage glaucoma and when to refer out if surgery is needed or if medication fails. I don't think its too much to ask for an attempt to have a nationwide standard of what ODs are allowed to do.

    In this ideal world, I doubt every state would go up to the level of Oklahoma. That being said, I also don't think its unreasonable for the ODs to desire to practice up to what their education allows.
  12. killbill2

    killbill2

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  13. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    Back to the main topic and let's keep this civil please.

    I agree with this. Unfortunately, optometrists are not trained to do the surgeries these bills are asking for. Optometric education is good, but without an established mechanism to train surgeons, then optometrists need to decide BEFORE making the choice: do I apply to optometry school or do I go to medical school. This is what I did before applying to medical school. I wanted to be a surgeon so I went to medical school. We waste so much time, effort and money in arguing about surgical privileges for health care providers who are not trained to do these surgeries.

    If optometrists want equal compensation for their work and punctal occlusion as well as minor "non-surgical" procedures, then ask for that in a federal bill. Why ask for permission to do everything short of general anesthesia when optometric schools are not training their students in these areas? This is what I don't understand.

    Again, please keep this discussion civil and polite. Do not post if you cannot be calm and polite.
  14. qwopty99

    qwopty99 Veterinary Optometrist?

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    Is there a link to the California bill?
  15. rubensan

    rubensan Senior Member Moderator Emeritus

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  16. KHE

    KHE Senior Member SDN Advisor

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    Would organized ophthalmology be willing to support such a bill?
  17. Mirror Form

    Mirror Form Thyroid Storm

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    So in other words, OD's scope of practice should be based up on what they feel they're trained to do? Okay, so why not train themselves to do lasers too? And then why not surgery?

    Unless the OD's can prove that the public would benefit, then they have no argument. Very few areas don't have access to ophthalmologists. Creating extra providers when there is no need in most areas will not improve patient care. Furthermore, glaucome is a lot harder to treat correctly than people think. If you're an OD who treats it all the time, then fine. Manage it medically and refer out when people need SLT or surgery. But if you're the type of OD who primarily refracts patients, and there are plenty of ophthalmologists around who treat glaucoma regulary, then it would probably be a lot better for the patient's overall prognosis to be referred out early.
  18. Caffeinated

    Caffeinated Army Strong

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    Excellent question. There are many factors what would come to play in establishing a national optometric standard for scope of practice. Here is my attempt to outline the issues and the potential roadblocks:

    1. Would ophthalmology support it? I don't think I know enough about "Organized Ophthalmology" to know the answer. But I know many ophthalmologists who would probably support it if it was a reasonable standard based upon what optometrists are trained to do. I am not going to go into details about what I think a standardized optometric scope should entail, but I think the majority of optometrists have a pretty good grasp on what their scope of practice should entail. Furthermore, I think that most ophthalmologists would find that they agree with this majority of optometrists.

    2. The "Organized Optometry" agenda is driven by a small minority of extremists who will not stop until the profession of Optometry is indistinguishable from Ophthalmology. Also, Optometry has partnered with politicians, lawyers, and lobbyists as a means to push their scope of practice agendas. It seems that Organized Optometry, in partnering with lawyers and politicians, have adopted a "shotgun" approach of pushing for privileges way beyond their training in hopes that the final outcome will be bargained down to a reasonable request. Think about how this looks from the Ophthalmology perspective: 1) Optometry has partnered with lawyers (a profession that is almost universally distrusted in the medical world), and 2) how is Ophthalmology supposed to distinguish between what Organized Optometry really thinks it ought to have versus everything else that is padded into these scope of practice bills? How does one separate the wheat from the chaff?

    2. Organized Ophthalmology is not without fault either. Organized Ophthalmology has also been known to partner with lawyers and politicians by attempting to enact (and sometimes succeeding temporarily) legislation that puts optometry back into the stone age by taking away things that optometrists are trained to do. It then becomes a game of "Who can push harder," or "My lawyer is better than your lawyer," or "Your politician's mother is soooooooooooooooooooooooo ugly......."

    3. If both sides of the aisle would clean up their own houses by pushing their extremists aside, it would be relatively easy to spend a few years hammering out a reasonable, well-delineated scope of practice that both sides find acceptable. However, the problems outlined in #1 and #2 above have occurred over the course of many years. This mutual distrust will be the biggest obstacle, and this obstacle will not be disassembled overnight. Needless to say, I am still optimistic that the future will be better for both professions.
  19. KHE

    KHE Senior Member SDN Advisor

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    It's not surprising that this insightful reply comes from someone who actually has a frame of reference and not a medical student or 1st year resident who is just regurgitating the same diatribe that their attending gave them last week. (I know, I know...he's a med student but he has much more of a frame of reference than just about everyone else on here)

    Very true.

    The reason that optometry partnered with lawyers and lobbyists was that we got absolutely zero support from ophthalmologists. We can all remember the ophthalmologists waving around the bottles of tropicamide in the state legislature hearings and ominously declaring that it could KILL people, which essentially implied that if ODs were allowed to examind the fundus, bodies would pill up all over the streets of America.

    This is also true and there are many examples of it. This is why I think it is important to sit down and have reasonable people from both sides come up with a reasonable plan that meets the needs of the public and the professions. At this stage of the game, it seems that both sides are so distrustful of each other that it's not likely to happen. Another issue for optometry is that we have gotten burned many times with having "formulary" type legislation and scope of practice that specifies which drugs, or which procedures can be done. We saw this in New York when Xalatan came on the market. The argument was made that since prostaglandin analogues were not included in the original bill, ODs could not use prostaglandin analogues. Then the argument was made that since ODs couldn't use the newest and most effective treatments for glaucoma, they shouldn't allowed to use any. ODs were suspended from treating patients that they had safely and effectively been treating for years. We need the ability to incorporate new technologies and treatment modalities into our treatment regimes. Unfortunately, ophthalmology always assumes that that means "do surgery" and they're basically wrong.

    Optometry has essentially gone for a scope of practice that includes "everything" not because we want to "do everything" but because we are tired of having to grovel before the medical society in all 50 legislatures every time some new drug or technology comes out. On some level, I understand the concern of ophthalmology here but we need to be honest with ourselves. The overwhelming majority of ODs work in their own (usually solo) private practices or commercial locations. There just isn't the volume of surgical cases in EITHER of these practice modalities to justify the expense of lasers or the pursuit of these priviledges etc. It's economically unfeasible. I am a partner in an optometric practice that is fairly "medically oriented" in the sense that we emphasize our examinations and our treatments much more than our material sales. We have a good working relationship with local primary care docs, internal medicine people and neurologists. Even in an office the size of ours, the volume of surgical cases that we send out in a month is incredibly low. We just don't see many of "those patients" anyways. It makes no sense for us to do them.

    But even as a hypothetical....let's say that we did see a high volume of surgical cases that we refer out...it STILL wouldn't make economic sense because if optometrists suddenly start doing "surgery" and even if only a small number of them do it, it has the effect of making a HUGE increase in the number of surgical providers but it keeps demand for those procedures exactly the same! Optometrists GET THIS. And this IS NOT what we want!

    You think we want $660 for a cataract extraction with all the attendant crap and corruption that comes along with it? You think I want to spend thousands of dollars on a laser to do YAGs and PIs, of which I see maybe one or two a month? I could see one or two extra patients and sell one pair of glasses and make the same money WITHOUT the attendant risk and aggrivation. THis is why I keep harping over and over again that this issue IS about money, but it's NOT about money from performing these procedures.

    Not only that, but optometrists tend to be OVERconservative to a fault. If anything, we OVER refer. The notion that optometrists, if granted a broad scope of practice are going to suddenly and recklessly rush out and start slicing and zapping the unsuspecting public is beyond ridiculous. Just as another person pointed out on here somewhere, you don't see ophthalmologists performing Whipples even though they are licensed to do it. It's no different with optometrists. Just because we would technically be licensed to do something doesn't mean we're all going to rush out and start doing it, or that optometry schools are going to suddenly turn into surgeon mills. It makes so little sense.

    I agree with this wholeheartedly. A brilliant and succinct response.

    Again, it's about money...but NOT money from procedures. We want to be able to adapt to new technologies and incorporate new drugs into our practices. And we want our patients back when we refer them out. I know....I know....the patients sometimes want to stay with the ophthalmologists. That's fine. And many times we're HAPPY to have the patients stay with the ophthalmologist. But please...let's not have any more of this crap where the ophthalmologist finds some "unusual astigmatism" that requires the whole family to be seen or the scenario where the ophthalmologist tells a mother that an OD recklessly treated their 14 year olds blepharitis with blephamide and how we aren't trained to use blephamide.

    There's plenty of pie to go around. Let's stop this silly bickering because all it does is makes lawyers and lobbyists rich.
  20. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    As a general rule, the refraction only ODs don't treat anything medically. They are the ones who send every red eye and whatnot to the local MD, no worries about them. I wouldn't give them a 2nd thought. Heck, even other ODs aren't very fond of them.

    Well, ideally the state board would decide what ODs have been reasonably trained to it. Same reason FP's don't do lasers either, they know their limits. I like to think that most of you doctor-type people know your limits. Listen to folks like KHE or Dr. Chudner, they know that as things are now ODs aren't trained well enough in almost all of the surgical procedures they don't already do to do any of the others. All most optometrists want is to be able to do the things they were trained to do. There are plenty who wouldn't do any of them, like said refraction only ODs, but there are also plenty who want to do these things and would do a fine job of it.
  21. Mye Eye

    Mye Eye Ophtho Cookie Eater

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    With all due respect, I dont know of any Ophthalmologists licensed to perform Whipples...but the rest of the argument definately sounds rather valid for sure and I understand what you're trying to say :)
  22. KHE

    KHE Senior Member SDN Advisor

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    Please correct me if I"m wrong....I was always under the impression that a medical license was a carte blanche to do whatever you wanted. I certainly understand that no hospital will credential an ophthalmologist to do a Whipple and there are malpractice issues involved but technically, you are "licensed" and "legal" to do it.

    Obviously it's an extreme example, and probably not the best one. Let me try again....

    Ophthalmologists frequently remove verucca and papillomas from eyelids for various reasons. They could probably just as easily remove ones on people's ears, but they don't.

    Why not? Because even though a papilloma is for the most part a papilloma, that's not what they really do day to day, correct?

    Is there any reason to think that ODs would be so reckless that they would run willy-nilly through the streets doing things that they aren't trained or experienced in just because they are "licensed" to do so?
  23. Mye Eye

    Mye Eye Ophtho Cookie Eater

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    This is not correct sir. As far as the MD goes, we are NOT licensed to do anything in the USA that we please. That is why we have residency. We are NOT licensed to perform any procedures for which we are not trained.

    General surgeons are only licensed to do Whipples under guidance of an attending in GENERAL SURGERY in the hospital for which they have privileges. People dont do whipples just because they are MDs...not because they arent trained for such (which they arent), but they are legally not allowed to do this simply based on having an MD. That is why we have specialty training, to gain the privilege of performing these operations. I think the example falls short in that it's a surgical procedure.

    We are, however, licensed to treat bronchitis, asthma, pain management, etc as we see fit and comfortably. We WERE trained for this in medical school...but NOBODY is licensed to perform Whipples merely on the merits of an MD degree. In fact, we may see them DONE in medical school, but there is no surgical training as to how to perform such operations (even being in the OR for these). Thus, we do not have the allowance to do this. We cant even legally perform an appendectomy alone upon completion of MD school even if we have seen 1000 of these on our General Surgery rotation.

    Is this honestly what you feel? We are allowed to do ANYTHING we want based on the merits of an MD degree? An internist is trained in internal medicine and can treat Cancer just as much as an Oncologist, however they obviously refer these to oncologists once stabilization so that the best care can be obtained...We on the other hand, as Ophthalmologists, are not licensed to treat oncology patients based on the mere medical school training on this field. So simply said, your perception is a misperception.
  24. MAYOphtho

    MAYOphtho

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    I think the short way to say this is that any Ophthalmologist performing a Whipple would lose their license in the US since they legally cannot perform these procedures based on only having an MD.
  25. KHE

    KHE Senior Member SDN Advisor

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    If this is the case, then I stand corrected. My understanding was that a medical license was a carte blanche to perform any medical procedure or initiate any appropriate medical therapy. Naturally, I know that residency, and board certification, and hospital privleges and credentialling, and tort law and a whole host of other factors are considered in who does what but my understanding was that from a strictly legal perspective, a medical license was a carte blanche, so I am happy to be corrected on this.

    But the point is obviously made that for the most part, physicians know the limits of their training and know what they are comfortable doing and steer clear from things they aren't though they may be technically licensed to do so. I don't think that there is any reason to assume that ODs en masse would be any different.
  26. Mye Eye

    Mye Eye Ophtho Cookie Eater

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    Fair enough, and I understand what you are saying as far as knowing their limits. There are always a few bad apples out there...think about the rare cases when you hear about some Doctor who is trained in (for example) Internal Medicine that is later found to have been portraying themselves as a Plastic Surgeon for the profits. This is a true case. He apparently took some weekend long course on this and thought even this allowed him to do this. When he was discovered, he immediately lost his license and was arrested. So you can rest assured the licensing boards prevent MDs from doing anything that is not within their realm of training. I hope this helps clear up any confusion.
  27. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    I hate to go against this, but everything I've heard technically agrees with KHE. As far as state law, at least here, goes, MDs can do pretty much anything they want. Civil suits, hospital privileges, and common sense keep this from happening. I'll give you an example. When we sold Dad's practice (OD) the new doctor wasn't credentialed for any insurance plan. We talked to the state boards (medical and optometry) and were told that the new ODs dad (neurosurgeon) could bill for everything his OD son did since according to SC law an MD can do pretty much whatever he/she wants to do barring those three things I mentioned above.
  28. MAYOphtho

    MAYOphtho

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    This may be true, but quick question, how does one explain the loss of license and arrest of the physician mentioned above by "Mye Eye?" I'm pretty sure I've heard of this same case and I believe what they wrote to be accurate...not saying anyone is right or wrong as well as all this goes, I'm more curious about this whole thing. Maybe it's because that doctor intentionally misrepresented his credentials to clients?
  29. qwopty99

    qwopty99 Veterinary Optometrist?

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    I'll just add that this misperception of "his" is a misperception probably held by a large number of the public.

    I too had heard of the "carte blanche" statement, and though I didn't necessarily think it meant that an MD was a license to do anything, I didn't explicitly know anything to suggest the contrary (except common sense, lawsuits, hospital privileges, insurance etc.).

    This "carte blanch" misperception is probably quite pervasive among those who have heard of the term.
  30. qwopty99

    qwopty99 Veterinary Optometrist?

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    To give an example of the opposite (I don't know that this is analogous or not), here's an example of a "cosmetic surgeon" who merely had family physician training, whose patient died after treatment.

    Canadian Woman Dies After Surgery
    http://www.psp-interactive.com/eReport/2007-09-28_01.asp

    The death of a Toronto woman from complications following liposuction has prompted Ontario to undertake a wholesale review of the regulation of cosmetic and aesthetic surgery, and sparked a national debate over which physicians should be allowed to perform invasive procedures.
    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2211354

    From the same CMAJ link,
    "In September, 32-year-old real estate agent Krista Stryland died following liposuction performed by Dr. Behnaz Yazdanfar of the Toronto Cosmetic Clinic. Yazdanfar is a family physician with no formal surgical training who claims on her website to perform a wide range of invasive procedures, including breast surgery, liposuction and tummy tucks."
  31. KHE

    KHE Senior Member SDN Advisor

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    The likely explanation is probably that while he can't be arrested for "practicing medicine without a license," his judgement was so negligent and so egregious that the medical board likely thought it prudent to revoke his license. I guess that would be akin to an ophthalmologist doing the Whipple.
  32. Olddog1

    Olddog1 Junior Member

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    I think MDs can do whatever they want. When you get a state license it says you have an unrestricted license to practice medicine. This means in the eyes of the state board you can do what you want. My license doesn't say ophthalmology. However, when you apply for hospital priveledges you need no mark exactly what procedures you want to do, the amount of post graduate training you have, and in some instances the number of times you performed a procedure, and it's outcome. That is really what limits scope for physicians. A hospital is not going to take the risk. Also, your malpractice carrier asks exactly what you are trained to do and how much training you have had doing it. Medicine has changed alot in 30 years. Gone are the days where THE doctor in town was the OB, general surgeon, IM, FP all rolled into one. However, this was not legislated out of existence, this mode of practice just became extinct. There is much more specialization and now there is board certification for all of the specialties. Ophthalmology is the same. The older docs would do eveything: buckles, muscles, PKs, trabs, plastics, etc... Now, that is extremely rare because suboptimal outcomes are not acceptable, the public has access to much more information, and there are so many fellowship trained subspecialist.
  33. Olddog1

    Olddog1 Junior Member

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    I think MDs can do whatever they want. When you get a state license it says you have an unrestricted license to practice medicine. This means in the eyes of the state board you can do what you want. My license doesn't say ophthalmology. However, when you apply for hospital priveledges you need to mark exactly what procedures you want to do, the amount of post graduate training you have, and in some instances the number of times you performed a procedure, and it's outcome. That is really what limits scope for physicians. A hospital is not going to take the risk. Also, your malpractice carrier asks exactly what you are trained to do and how much training you have had doing it. Medicine has changed alot in 30 years. Gone are the days where THE doctor in town was the OB, general surgeon, IM, FP all rolled into one. However, this was not legislated out of existence, this mode of practice just became extinct. There is much more specialization and now there is board certification for all of the specialties. Ophthalmology is the same. The older docs would do eveything: buckles, muscles, PKs, trabs, plastics, etc... Now, that is extremely rare because suboptimal outcomes are not acceptable, the public has access to much more information, and there are so many fellowship trained subspecialist.
  34. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    It is true that hospitals may not credential you, but it doesn't stop a MD from opening his/her own ASC to perform surgery.

    This applies to both MDs and ODs: "you don't know what you don't know".

    The problem with optometry training is that there is no uniform surgical training for the profession. The OD's simply "don't know what they don't know" in regard to surgery; yet, they push bills to grant them "what they don't know".

    The problem with MDs is that they think they know even when they know they shouldn't be performing surgeries outside their scope of practice.

    Both are problems. However, bad MDs deal with an established medical board. But bad optometrists will deal with their own optometry boards not experienced enough to deal with surgical issues or privileges.

    I understand that money is an issue, but we must always ask if our patients will be better served by allowing two tiers of surgeons to be trained in intraocular surgery?
  35. KHE

    KHE Senior Member SDN Advisor

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    You keep insisting that optometrists want to perform intraocular surgery. I don't know what more I can do or say that will convince you otherwise. This isn't what we are fighting for. We are fighting for control of our profession, not so we can do intraocular surgery, but so we can continue to evolve and grow as a profession as new technologies and therapies come available. You'll likely interpret that as "cataract surgery" or something like that, but you would be incredibly far from the truth.

    You will likely post some link, or make some quote from some OD who is desirous of eliminating general ophthalmology and performing surgery himself. Yes, there is a small handful of ODs who for whatever reason, are desirous of performing surgery. But I'm telling you for the 100th time that that is not the primary motivator of 99.99% of ODs.

    I have outlined on here at least 5 times what the issues that concern ODs are and they do NOT include the desire to perform intraocular surgery, yet not a single person on here has offered up a reasonable solution, or a reasonable compromise to this issue. I imagine that there will be a trite response like "go to medical school" or something like that, but that's not going to help this solution. ODs are reasonable people. I've told you want we want. Offer something up, or we're just going to continue to carry on the way we are which unfortunately just makes lawyers rich.
  36. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    Respectfully, this is your opinion and point of view. The goal of your leadership is different. It has been stated to the AAO leadership from several leaders in optometry that organized optometry has the goal of performing cataract surgery.
  37. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    The trick is, this varies greatly from year to year. One year, the president of the state optometric association said that if ODs could do Yags then he would be happy and not push for anything more. The very next year, a new president expressed interest in wanting to do cataract surgery. Last year, a third president cared nothing for scope expansion and devoted all of her energies into insurance parity. Like everything else, there's great variation from year to year depending on who is in charge.
  38. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!

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    Right.

    And in the meantime we're supposed to just sit here and say "no need to stick up for ourselves, the next state OD pres is not going to care about ODs performing surgery?"

    Not a chance buddy. I will fight TOOTH AND NAIL for what we deserve (and for what you don't).

    Although KHE brings up some legitimate points (economics of OD's performing surgeries/doing YAGs, etc) he is NOT the President, OD that makes the decisions for the rest of them.

    Until that time, his opinion is just that -- his opinion.
  39. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    I was not suggesting that ophthalmology do that, just sharing my personal experiences and suggesting that you don't need to always do anything - just be vigilant and be ready to deal with something when it comes up, there's no need to be preemptive all of the time.

    I'm a medical student as well so technically I deserve everything you do (depending on residency of course), but I always appreciate being condescended to.

    No argument there, I think we're both just trying to say that things are not as bad as you seem to think they are. As I mentioned, I'm not suggesting that y'all just give up - I just think keeping a watchful eye out will be sufficient to accomplish whatever you need to in regards to organized optometry.

    I tend to think that, generally speaking, optometry and ophthalmology can just ignore each other politically most of the time and everything will be just fine. When things do become troublesome, you should certainly do what you think is right. There's just no need to be militantly anti-optometry 100% of the time.
  40. KHE

    KHE Senior Member SDN Advisor

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    I strongly disagree with this.

    Is that something that you heard yourself personally, or is it something being propagated by your own AAO? Can they name a person, or a list of optometrists who have publicly stated that as their goal?

    I am involved in my state association and not even once has the topic of intraocular surgery ever come up. There is one guy who is somewhat desirous of doing LASIK, but that's ONE GUY.

    I maintain that the issue for optometrists is not the desire to perform surgical procedures, the scant few renegades not withstanding. It is the desire to be able to adapt to and get paid by third party payors for new technology and theratputic modalities without having to grovel before the state medical board every time a new eye drop or machine comes down the pike.

    For the 10th time, why would ODs want to perform cataract surgery for $660? I refer out about 3 patients per month for evaluation of cataracts. I'm going to spend all kinds of time, money, energy political capital so I can earn an extra $1980 per month? I can come up with thousands of more expedient ways to raise that kind of money in my office than farting around doing cataract surgeries, and 99% of ODs are in the exact same boat as I am.
  41. Ben Chudner

    Ben Chudner Senior Member Moderator Emeritus Lifetime Donor SDN Advisor

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    Dr. Doan, I have a lot of respect for you based on what you have posted over the past several years, but I seriously doubt what you stated above is true. I have never heard any leader in optometry ever make that claim, let alone discuss it with the AAO leadership. There may be a few vocal OD's that want surgery, but those guys have never been considered leaders nor do they speak for organized optometry. If you could provide some info about who made these claims, I would be happy to do a little research however, with all due respect, the AAO leadership has a history of making misleading statements with the intent of eliciting a reaction.
  42. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    Do some research on the optometrists leading the charge in Oklahoma.

    And now, there is a federal bill (HR 1983) being presented to ask for the option of intraocular surgeries, lasers, and injections. It's clearly stated on paper. HR 1983 states:

    (2) by inserting before the semicolon at the end
    9 the following: ‘‘, and (C) medical and surgical serv
    10 ices furnished by an optometrist (described in sec
    11 tion 1861(r)(4)) to the extent such services may be
    12 performed under State law either by a doctor of
    13 medicine or by a doctor of optometry and would be
    14 described in clause (A) if furnished by a physician
    15 (as defined in section 1861(r)(1))''.

    At the federal level, optometrists want medical and surgical rights granted to EITHER "a doctor of medicine or by a doctor of optometry". You can state that you don't want to have equal medical or surgical rights here in the forums. But your leadership clearly is pushing a bill that suddenly grants optometrists the right to have medical and surgical services performed by "doctor of medicine". This bill is extreme if you're only asking for foreign body removal and punctal plugs. The political rhetoric is written with purpose. I only see here the setting of the stage for intraocular surgeries.

    First pass a federal bill. Then allow Oklahoma or California to train surgical optometry. In ten or twenty years, we will have either the medical surgeon or optometric surgeon.
  43. KHE

    KHE Senior Member SDN Advisor

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    I'm starting to feel like I'm talking to a fire hydrant here...

    Dr. Doan....that bill simply states that optometrists shall be paid by federal programs for procedures that they are currently licensed to do under STATE law. Right now in Connecticut, optometrists are excluded from certain state medicaid programs that are administered by the state but the funding comes from the federal government. This is a common occurance in many states. I can see patients who have state funded medicaid programs, but not certain federal funded medicaid programs. It's crazy. That bill simply eliminates that problem. The "political rhetoric" is written for the purpose of allowing optometrists to expand their diagnostic and treatment modalities as technology evolves without having to continuously grovel to the 50 state medical boards. Again, I imagine that you are sitting there thinking that that is code for "do cataract surgery" but you're wrong and sadly it seems that despite any evidence that I present to the contrary does not allay your fears.

    Your continued belief that optometrists are going to set up second tier or alternate routes to intraocular surgery is unfounded, despite what the AAO has fed you. I would still appreciate a source for your claims that "organized optometry" has declared it's intention to the AAO to pursue intraocular surgery.

    What "optometric leaders" have said, and what optometric organization has adopted that as a policy? Please don't send me a link to some letter to the editor in Optometry Times from some OD in Kentucky who wants to do LASIK. Please provide names of "optometric leaders" who have declared intraocular surgery to be the publicly stated goal of the organized optometry.

    I state again....it makes no clinical sense, and it CERTAINLY makes no economical sense for ODs to be performing intraocular surgery. We don't see enough patients who need it for us to ever be good at it, and we certainly don't see enough patients to make it economically viable either for the individual practitioner or the profession as a whole. Again I ask....what will happen to reimbursement when we triple the supply of providers but leave the demand the same? I don't need the measly $660 for a cataract extraction. I don't need to set up an ASC. Even if I wanted to set up an ASC in partnership with 10 other ODs, none of us have anywhere close to a surgical volume to make it even close to profitable, the attendant malpractice and liability issues not withstanding....the procedures themselves simply don't generate the revenue to make it viable.

    I don't know how many more times I can say this....this is about the future destiny of the profession. You can read "cataracts and LASIK" into that if you wish, and I don't seem to be able to convince you otherwise, but if you wish...please offer up a solution. What is organized ophthalmology going to offer up to address our issues? If the answer is "nothing" or "go to medical school" then we're pretty much finished here.
  44. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    KHE, I am part of the AAO Leadership as I serve on both the Young Ophthalmolgist Committee and Federal Congressional Advocacy Committee. The writing is on the wall as seen by the State Bills that are being pushed in New Mexico, New Jersey, Oklahoma, and California for surgical privileges for intraocular surgery. These bills go beyond the medical privileges that you seek. If this is not evidence enough, then I don't know what is.

    Because optometrists do not advertise anterior segment surgeries now, you will not see the volume. However, once optometrists start advertising, the surgical volume will increase. It is economically lucrative. More lucrative than the average incomes of the average optometrist.

    The average ophthalmologist performs 10 cases per week. At $660/case, that's $290,400 of revenue for 11 months of surgeries. There are surgeons in rural areas doing 40-60 cases per month. Consider multi-focal IOLs, 5-10% of the patients will want to have these IOLs that will add $2000-$4000 to the bottom line per case.

    Increasing surgeons will not necessarily decrease the $660/case reimbursed by Medicare. The $660 is work-load credit based on RVUs, and not based on supply of surgeons. Because the work-load will be the same, the $660/case reimbursement will not decrease. The decreases in the $660/case will be due to the fact that Medicare is broke, and congress plans to cut 15% in reimbursement next year. On the other hand, increasing supply of surgeons, will decrease the cost of multi-focal IOLs (i.e. $2000-$4000 per IOL), but this is icing on the cake.

    If you setup an ASC, you'll make even more money as you'll earn RVUs from cases done in your ASC.

    Economically it does make sense.

    At the present time, there is some talk of allowing optometrists to apply to residency but nothing is set forth as a formal offer or consideration.

    On the other hand, there's nothing wrong with "going to medical school". Students need to be better informed before entering graduate programs. Ask first, do you want to do surgery. If you do, then go to medical school. If you don't, then go to optometry school.
  45. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    I might be able to answer here. In the 10 or so years that I've kept an eye on my state's optometry organization, I've noticed that they always ask for more than they expect to get put into law. Many of the MDs here are vehemently anti-optometry and would fight ODs trying to get permission to use a new tonometer much less any new drugs/procedures. Hence, the ODs always asked for way more than they wanted or even thought they had a shot in hell of getting. That way ophthalmology would be so busy fighting the fringe parts of the bill that optometry could then concentrate on the parts they really wanted.
  46. Ben Chudner

    Ben Chudner Senior Member Moderator Emeritus Lifetime Donor SDN Advisor

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    Dr. Doan, this is not evidence of optometry's push for surgical rights. The bills you speak of are the result of ophthalmology negotiating with optometry on a bill only to fight the compromise once it is brought before the state legislators. This time, optometry decided to submit a "pie in the sky" bill so that several things could be taken out (ie surgery) and the bill as we want it might get passed.

    I took your advice and looked into Oklahoma optometric leaders. As it turns out, one of the members of my study group is the guy who actually wrote both the legislation and the board rule in Oklahoma. He is one of the leaders of organized optometry in Oklahoma and he has the death threats to prove it (impressive response by ophthalmology). He, as well as other leaders are on record as repeatedly saying that OD's do NOT want or plan to do intraocular surgery. No leader has ever told the AAO in Oklahoma that OD's want to perform those procedures.

    It is true however, that your president, David Parke, went on record both in print and during testimony in OK saying that he heard from organized optometry that OD's want to expand our scope to include intraocular surgery. When he made that statement during testimony in front of the OK legislature he was asked by a Senator for documentation of the claim. He was unable to provide any proof and wound up saying, "I don't know where I heard it, but I know it's true".

    The bottom line is that neither KHE nor myself are going to change your mind here. I can see how some of the recent state bills could cloud your judgement, but that's because you have no idea of the political situation in those states. I can also understand that you want to believe your leadership, but that's because you weren't around to see MD's hold up a bottle of phenylephrine and state under oath that one drop of it could kill a patient in the wrong hands. Our side my be aggressive, but that's due to years of lies and misinformation being spread by your leadership. You may think California, New Mexico, New Jersey, and Oklahoma want to push surgical bills, but the truth is that they wanted a bargaining chip. What better way to negotiate than to give up something we don't want in order to get what we really deserve.
  47. Mye Eye

    Mye Eye Ophtho Cookie Eater

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    So why would we believe then that you dont want something you put in a bill? Are we (and even you) supposed to READ BETWEEN THE LINES as to the things you really do want, and the things you say you want in a bill (but dont really want)?
  48. Ben Chudner

    Ben Chudner Senior Member Moderator Emeritus Lifetime Donor SDN Advisor

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    No, we are not to read between the lines. What we should do is sit down and discuss in good faith what each profession believes is appropriate. I really believe that if the national leadership of both professions sat down at some sort of summit, there would be very little that they would not agree on. Instead, what we have is ophthalmologists agreeing on a bill after months of negotiation, only to fight it once it is introduced. Furthermore, if we could get the ophthalmology leadership to actually understand what we want and let its members know instead of misrepresenting our intentions, maybe we could actually come up with an appropriate national scope of practice that does not need to be altered every time a new drug or minor procedure is introduced.
  49. alleyesonme

    alleyesonme

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    Where do optometrists stand on whether they should be able to do intravitreal injections? With all the the new antiangiogenic therapy, do they feel they should be able to manage patients with ARMD, DM, if treatment consists of monthly injections?
  50. DOCTORSAIB

    DOCTORSAIB Ophtho or bust!

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    Yes, of course. Might as well...:rolleyes:

    If the patient needs it, let's get 'err done!

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