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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, 04.28.04.

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Do you support Optometrists doing surgery?

  1. Absolutely No: MD/DO/medical student

    682 vote(s)
    57.5%
  2. Absolutely No: Optometrist/Optometry student

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

    120 vote(s)
    10.1%
  4. Yes w/ proper optometry "surgical fellowships": MD/DO/medical student

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

    96 vote(s)
    8.1%
  6. Yes w/ proper optometry "surgical fellowships": All others

    56 vote(s)
    4.7%
  7. Absolutely Yes: MD/DO/medical student

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

    25 vote(s)
    2.1%
  9. Absolutely Yes: All others

    21 vote(s)
    1.8%
  10. Undecided

    40 vote(s)
    3.4%
  1. DKofLV

    DKofLV

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    SDN Members don't see this ad. (About Ads)
    Now before I make this statement, look at my history...it's rare that I knock ODs on the forum

    BUT

    if you dont like what's said here, then get the heck out of the forum...I honestly dont care enough about ODs' opinions of us to troll the forums you guys run on here...so why should you care what we say about you here? do you really have THAT much free time? I mean, I know never being on call is awesome and all...but still...

    (yes, you can say: It's b/c of lies/mistruths/insults/etc that you are here to respond to, but let's be honest...if we went to the OD forums, it'd be full of the same or worse)
  2. KHE

    KHE Senior Member SDN Advisor

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    20 % is the percentage that MEDICARE ITSELF says is the acceptable rate to not be in violation of any sort of anti-kickback problems.

    Virtually ALL of the patients I refer out wish to be co-managed because the surgeon is a 20 minute drive away in the next town over and I'm a 3 minute drive away. Is 20 minutes drive a burden? Not for most of us I would say but for seniors and/or their caregivers and/or the nursing home they live in and/or their children who shuttle them around, 40 minutes round trip in a day as compared to 6 can be a pain in the middle of a busy day.

    And again Dr. Doan, if I had my druthers, you guys could ALL TAKE ALL THE SURGICAL MANAGEMENT YOU WANT! I don't WANT to do it. I LOSE MONEY doing it! I already showed you that.

    The article you posted is from 2000. Here, it's 10 years later and this whole issue is a non starter. I already said that YES, at the very height of the refractive surgery boom 10-15 years ago there were probably some illegal relationships throughout the country though most of them seem to be concentrated in southern California, and as another person said most were initiated by ophthalmologists! But even in that outdated and tired article, the example shown is that the OD takes over 90% of the postop management and receives the grand total of $133. Oooooohhhhhh......someone call my stock broker and my travel agent to book that trip to Tahiti. A whole big $133! For how many office visits? 2? 3? Ooooooooooooo. Be still my beating heart.

    But that $133 represents only 90% of the post operative period. What if I was one of those crazy, renegade, money grubbing ODs who cared only about money and not about patient welfare and I insisted on doing the one day and the one week visit as well? That would get me an extra $13.30.

    YESSSS!!!!!!

    This whole thing is much ado about nothing.
    Last edited: 04.25.10
  3. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    Everyone I saw referred from an OD was given a consent form that, yes, was filled out as though the patient was going to go back to the OD but I did see a few request to stay with the surgeon after surgery.

    At the OD offices (at least the 2 I worked in) the patients were told how the co-manage deal worked and referred to the surgeon that participated. Not all the patients went to him. Some already knew a different MD, some went to the pre-op appointment and didn't like the co-managing MD.

    Perhaps my experience is unusual, but I'm just not seeing the paternalistic handing off of patients that you seem to have encountered.
  4. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

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    Yes, I completely agree with this! This is what co-management was intended for, to provide the best care for the patient.

    In areas where you can throw a stone and will hit several eye surgeons and optometrists, this is where co-management can be illegal if the patient does not have informed consent and/or the physicians involved pre-arranged the co-management.

    Also, I agree that some eye surgeons are at fault in regards to establishing "questionable/illegal" co-management arrangements. Greed is an ugly beast. I don't blindly endorse the activities of *all* ~16,000 eye surgeons in the US. The American Academy of Ophthalmology has outlined a policy relating to co-management:
    http://www.aao.org/about/ethics/upload/Employment-Referral-Relationships-2007.pdf

    Last edited: 04.26.10
  5. PBEA

    PBEA Senior Member

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    I will gladly crush any commentary on any open forum that I don't find to be truthful. I do the same in OD forums.
  6. DKofLV

    DKofLV

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    Hey solo member of your delusional "Team Awesome"

    (1) you didnt crush anything, and nobody cares
    (2) you continue to confirm you have too much time on your hands if you come to the OMD forums to argue points...I'm too busy to go check out or care what ODs are saying in your rooms...

    it's rough having no idea what being in the ER at 3am for a trauma to the eye, but I think you'll somehow survive and fill your time...
  7. bungo

    bungo Junior Member

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    Congrats on being the most insecure person on the internet. If you had spent some time with psychiatrists, you know in this medical school place you like making fun of, it would be easier to realize how stupid you look. Consider lobbying for some introspection next time congress meets.

    :laugh:

    But seriously (wo)man, don't take this stuff so seriously. It's the internet. Find real causes in the real world to spend your apparent copious amounts of free time on.
    Last edited: 04.27.10
  8. PBEA

    PBEA Senior Member

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    First ophthalmology/optometry, and now psychiatry? As a medical student, you clearly are above average. Congratulations on mastering these complex materials. Does your vast knowledge have no boundary? You sound like some GPs I've come across, you know the ones who equate empirical judgement with expertise :rolleyes:

    Run along now med student, try again in 10 years when you have a clue.
  9. PBEA

    PBEA Senior Member

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    thanks you so much for setting me straight, I feel much better now. Oh and you are right about the ER, I feel so humble in your prescence. The earth shakes from your mighty footsteps.
  10. DKofLV

    DKofLV

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    They arent mighty footsteps, I've put on a few extra pounds...thank you very much...

    but feeling humble in my presence (thanks for adding the extra "c" to your version of the word) really doesnt make me feel all gooey and happy on the inside, but thank you :thumbdown:
  11. Meibomian SxN

    Meibomian SxN

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    This is one of the best and more realistic answers I have seen. Most residents/fellows etc are not exposed to the real world until they are finished. Be it legal/illegal, these situations are a REALITY!
  12. Meibomian SxN

    Meibomian SxN

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    In a court of law the optometrist is a doctor, so they would be held responsible for their portion of any malpractice.

    In this case it seems the referring optometrist and co-managing ophthalmologist should have a better working relationship than that. The optometrist should have communicated the findings to the surgeon and they discuss the plan together.

    Out of curiosity, why did ANOTHER eye surgeon refer HIS post-op to you? Was he out of town and you covering his patients on leave....?
  13. Visionary

    Visionary Medical Retinologist

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    Bucknut101 is listed as a fellow, whether currently or not. I'm guessing the subspecialty is Cornea, which would be an appropriate referral for a persistent wound abscess.
  14. bucknut101

    bucknut101

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    Visonary is right on. I'm a cornea fellow so that's why HIS postop was sent to ME. He didn't feel comfortable taking care of the patient's problem so he sent it to a subspecialist.
  15. Meibomian SxN

    Meibomian SxN

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    Understandable; especially given the circumstances. Nice work :thumbup:
  16. Kevin4Eyes

    Kevin4Eyes

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    I'm starting optometry school in the fall, it is disheartening to see forums like this. Ophthalmology and optometry should be working together better. I chose optometry specifically because I do NOT want to be a surgeon. I did consider applying to medical school to go into internal medicine or primary care, not ophthalmology. Most ODs I have met at most just want the rights to do everything diagnostically and therapeutically OTHER than surgery, so fluoresceine angiography, things like that. Do most ophthalmologists like doing "primary eye care" anyways, routine vision care? If I was an ophthalmologist I think I would love getting surgical referrals from ODs to do the big buck procedures, then send the patient back to them for co management, and giving me more time in the OR.

    And if ophthalmologists were to change their name to "ocular surgeon" wouldn't they need to start doing surgical internships?
    Last edited: 10.26.10
  17. orbitsurgMD

    orbitsurgMD Senior Member

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    What makes you think they don't do that already?

    Many ophthalmologists have done surgical internships, including this writer. It can make for useful experience, but it is not required.
  18. JMK2005

    JMK2005 Member

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    No, going through a surgical ophthalmology residency makes an ophthalmologist an ophthalmic surgeon.
  19. Kevin4Eyes

    Kevin4Eyes

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    Not being required is kind of my point, I know some have done them, but maybe it should be, I mean if we are going to have a forum on ocular surgical education. How many other surgical specialties don't require one besides DPM and DDS? I know a few ENTs who think ophthalmologists should be required to do them.
  20. JMK2005

    JMK2005 Member

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    I still don't understand your point. ENTs don't know what we do enough to say that a surgical internship is required for ophthalmologist. I don't think you really know what we do.
  21. Kevin4Eyes

    Kevin4Eyes

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    Oh, I think I see your point, so you're saying that ocular surgery is so specialized, and that the micro techniques necessary to perform it can be acquired without going through a more traditional form of surgical education.
  22. JMK2005

    JMK2005 Member

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    Yes, that is what I am saying.

    It is an ongoing question among medical student applicants regarding if it is better to do a surgical internship versus a medicine internship.
  23. Kevin4Eyes

    Kevin4Eyes

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    Okay, but you failed to pick up on the whole "techniques necessary to perform it can be acquired without going through a more traditional form of surgical education" and the initial topic of this thread.
  24. JMK2005

    JMK2005 Member

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    I have not gone through the extensive discussion on this thread. Can you summarize the issue at hand?

    The topic of this thread is regarding optometrist doing surgery, not regarding ophthalmic surgical training. An ophthalmology residency trains a person to perform ophthalmic surgery, regardless of having done a surgical internship.
  25. Kevin4Eyes

    Kevin4Eyes

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    So if an OD did a three year residency should they be allowed to perform ophthalmic surgery?
  26. JMK2005

    JMK2005 Member

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    I think an ophthalmology residency would train anyone proficiently in the technical aspects of performing eye surgery.

    The other question is whether there is a need for an alternate route to enter an ophthalmology residency. I don't think that need exists. Currently, the route to perform eye surgery is to go to medical school, internship, and residency. Optometrists enter school understanding the limitation of their education. If an optometrist wants to do surgery, they should suck it up and go through the pathway that has already been set which means medical school.

    The argument for legislation in Oklahoma for more invasive surgery was because lack of access to ophthalmologists. I don't believe there is currently a shortage of ophthalmologists. Access to any specialists in rural areas will always be a problem. Certifying optometrists to do more surgical procedures is not the answer to the lack of access and certainly does not guarantee that these individuals will practice in these underserved areas.
    Last edited: 10.27.10
  27. Just Applied

    Just Applied Senior Member

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    While In theory this idea sounds simple enough, in reality, it takes a significant amount medical knowledge to understand the complications of ocular surgery. Yes, when things go great and there are no complication it seems manageable. When it really hits the fan is when the medical knowledge you gained can save the situation you are in. It takes a lot of knowledge and skill to be able to cut into an eye with knowing the possibility of blinding them. This skill should not be taken lightly or half halfheartedly. I do not know the specifics of optometry school, but I feel a certain amount of the medical knowledge I have learned in school will not go to waste.
  28. Kevin4Eyes

    Kevin4Eyes

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    To be honest with you, I do agree. I said earlier that I am going into optometry because I like primary care, and if I went to med school it would be for something like internal medicine, not surgery, and if somebody has a dream of being an ocular surgeon and they are debating between going to med or optometry school, they should obviously go to med school. However, sometimes people do get their OD and then decide that they made a bad decision, and paying another 130k in tuition and taking another biochem class as an M1 that they already took as an O1 seems counterintuitive. DOs do allopathic residencies, so it doesn't seem like too much of a stretch (in my mind) for an OD to do a comprehensive ocular surgery residency, but I understand that ophthalmologists want to preserve their profession as well.
  29. Untraditional

    Untraditional A bit late to the party.

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    If you want to do an MDs job get an MDs training. This backdoor pathway to calling oneself a "real" doctor that the NPs, PAs and even the Chiros are using has got to be closed.
  30. pbi

    pbi

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    I would be curious to see what percent of optometrists/optom family members in OK who require surgery are choosing to have it done by an optom- over an ophthalmologist.

    My hypothesis is exactly 0%
  31. Commando303

    Commando303

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    Interested by this topic, but loath to read through twelve pages' posts — the latest of which was made more than six years ago (in 2006) — I'll just restart the matter, myself.

    How do people feel about this? I'm in favor of O.D.s' being permitted to perform mildly invasive procedured, as long as they complete the additional education necessary (which I don't believe is possible only via all the stuff that leads to an M.D./D.O.) to do so with competence.

    That said, I also feel O.D.s who wish to enter ophthalmology should be able to do so via an abbreviated route to a medical degree.
  32. thiaeyemd

    thiaeyemd New Member

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    How would oral maxillofacial surgeons feel if ODs are allowed to do surgery. OMFS spend years in extra training to get their MD to perform surgery. Not to mention that ODs do not do a proper internship (no...calling your senior year of optometry school internship) is not the same as a real medical internship. I think it is just plain absurd. As a surgeon, I feel that the eye surgeon training is not even enough to produce properly trained surgeons and that we need to increase the training. And now there are a group of people who believe that not doing any surgical training at all is ok? to be able to perform surgery on patients. Are you kidding?

    In response to the question of how many patients in OK have ODs perform surgery vs MDs, it has to do with education. Most patients don't know the difference between OD and MD. In their mind a doctor is a doctor be it medical doctor, doctor of podiatry, doctor of optometry or doctor of psychology. The fact that ODs are trying to change their names to optometric physicians is just part of the problem. It is all about using confusing language (Doctor of Optometry, optometric physician) to confuse the average layman. My cousin is an anesthesiologist and he was telling me that the nurse anesthetists introduce themselves to patients saying " Hi I am John Smith, I am a member of the anesthesiology team" or "I am John Smith from Anesthesia" instead of Hi I am John Smith your nurse anesthetist" It is the slight play on words so the patient doesn't question their care as second rate. The real question is how many optometrists in OK are having their own or family's surgery done by ODs.

    When I rotated through a military hospital I had several senators and congressman that came to the eye clinic for emergency care. The ironic thing was that the same politicians who were given tons of money by OD organizations to vote for surgical rights were the ones not only demanding that an ophthalmologist not OD see them but that it had to be an attending and not a resident. When it came to themselves they knew what to demand but not for their constituents.
    Last edited: 01.12.11
  33. Retinopathy

    Retinopathy

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    What kind of "emergency care" did they need? Was it really necessary for an attending (or even a resident) to perform whatever procedures these politicians needed? ... or could an optometrist have done the job just as fine? We both know the capabilities and patient care that ophthalmologists and optometrists can provide, separately. I believe that there is a very defined line. So much that we can co-manage patients without really stepping on each others toes.

    In real life, patients think they need to see an ophthalmologist for conjunctivitis or foreign body removal... sometimes even for a refraction. They don't understand our scope of practice, we define it for them. Ophthalmologists shouldn't worry about optometrists trying to expand their scope of practice into surgery. Most optometrists don't even want to perform surgery.. it's not what we learned and it's not what we are here for.

    We won't be performing LASIK on your patients, removing cataracts, performing laser photocoagulation on diabetic patients with retinopathy, etc... I don't see this sort of thing happening at all. What I do see are patients coming in with spec and cl rx's from ophthalmologists, patients with red eye that have been wrongfully diagnosed as bacterial conjunctivitis by their PCP (not ophtho), and just basic patient care that optometrists are prepared and trained to do.. but patients, though a minority, still go somewhere else for treatment. It isn't possible the other way around. There are no worries there for ophthalmologists.

    If we were granted the rights for surgery, I'm not sure how many optometrists would actually take that on and be held liable. Not something of desire for me, anyway.

    I will admit I did not read all 11 pages of this thread.. but ODs in OK were granted surgical rights? Has anyone had any experience with an OD performing surgery and what was the outcome? I'm curious to know if it is practiced and to what extent.
  34. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    So residents should not be allowed to practice medicine?
  35. socal2014

    socal2014

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    Of course!

    MD's are over-rated, as per the poll. Obviously OD's would need more training, perhaps a 1 year residency.
  36. VA Hopeful Dr

    VA Hopeful Dr Senior Member

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    How on earth did you get that conclusion from this poll?
  37. eyesupply

    eyesupply

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    Ophthalmologists training is already too short. Ophthalmologists should not be doing surgery, much less optometrists! OK, not quite.

    In the UK, residents finish with triple the number of cataracts and have more experience in other things.

    In Canada, ophthalmology residency is longer than in the US.

    Most ophthalmology residents look for the cushiest internship and should be doing some hands on general surgery, particularly if they do any eyelid surgery.

    Optometry schools should be taken over by ophthalmology residencies. It would do society a service. Currently, some OD are very defensive and insist on their qualifications. Merging OD schools with ophthalmology residencies would solve that problem. ODs should become MDs and med school class size should increase somewhat to accommodate these people. Of course, this will never happen.

    If OD do surgery, ophthalmologists should be allowed to do colonoscopies. I did one as an intern. It is cool and also pays well. The justification could be that ophthalmologists do routine ones and refer the difficult ones to gastroenterologists.
  38. ABaverage

    ABaverage

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    I don't follow your logic... at all.

    Ophthalmologists shouldn't be doing surgeries? They have been doing just fine for the past.. umm... forever.

    Second, you believe in doing away with optometrists altogether. According to your posts, ophthalmology residencies should "take over" optometry schools and optometry students should just be medical students. That way we just end up with one profession, rather than the two- ophthalmologists. On top of that, you want to add additional years to the ophthalmology residency since you think that US ophthalmology residency program is insufficient for surgery.

    No, you cannot say that if optometrists perform surgery, then ophthalmologists should be able to perform colonoscopies. Where is the relation!?!

    Bless your heart, you are out of your mind.
  39. Meibomian SxN

    Meibomian SxN

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    One OD who spoke at a CE said he has a practice "next to" Lenscrafters and does PRK using a surgery center. He said he would put his PRK results up against ANY MD....

    I think it depends what you define as surgery. Putting in punctal plugs is listed under surgical procedures, and so is lash epilation. There are procedures a "properly trained" OD can perform and other procedures are better left to those who perform them more frequently.

    But the OD's education most certainly qualifies them to perform many of these non-invasive surgeries. All that is needed is a proper training and certification.

    The same way MDs get certified to perform new procedures....
  40. Meibomian SxN

    Meibomian SxN

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    Why not? If you are confident in performing colonoscopies without fear of perforating anything, then why not? You're license allows you to do such. I know of an oMD who also does the sleep clinic thing, and as an adjunct to cosmetic surgeries he infrequently performs tattoo removal!

    Sky's the limit with your degree so why not take advantage? Heck, you could start delivering babies also and refer out when things get too complicated...
  41. ABaverage

    ABaverage

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    I'm pretty stupid when it comes to MDs and what they are allowed and not allowed to do.. but an oMD who performs tattoo removal just sounds so.. wrong? :confused:
  42. DiveMD

    DiveMD Giggity giggity!!!

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    Need a medical degree but don't have the time or credentials to go to med school? No worries! Lobby your state politician today and start practicing medicine now!
  43. orbitsurgMD

    orbitsurgMD Senior Member

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    Why is it wrong?

    There are some very popular dermatological procedures that do not properly have a home from the standpoint of a specialty that trains residents to do them. Tattoo removal is one of them, so is hair transplantation and hair removal, and there are others. Plastic surgeons, dermatologists, ophthalmologists, ENT surgeons, OMFS and family practice all have done these. Some specialists claim primacy, but their residencies no more train them than any other to do these procedures, so they sort of remain up for grabs. Tattoo removal requires an investment in equipment, lasers, that is a barrier to entry--you don't do these at a hospital or outpatient surgery center--and while a cash-pay procedure it also requires dedicated advertising which is another cost barrier.
  44. Crystal Vision

    Crystal Vision

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    I don't think optometrists should do surgery. It should be left to the qualified professionals. Only ophthalmologists are qualified perform surgery. Go to medical school if you want to be a doctor.
  45. optojourno

    optojourno

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    Hi,

    I write for a publication called Primary Care Optometry News, and am writing an article on surgical privileges for optometrists. I'm looking for ODs who are in favor of optometrists having privileges. Interview can be done by phone or email, but my deadline is very soon. Please contact me at [email protected] if you would like to be interviewed.
  46. Shnurek

    Shnurek

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  47. Meibomian SxN

    Meibomian SxN

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    Messages:
    696
    Status:
    Optometrist
    SDN 5+ Year Member
    As taken from the OD forum, maybe you could contact this doc:

    http://www.ardmoreite.com/features/x1293126637/Local-doc-restores-man-s-vision
  48. EyeFlyGuy

    EyeFlyGuy Optometrist

    Joined:
    09.20.12
    Messages:
    2
    Status:
    Optometrist
    optometrists can get hospital privileges now. You really should learn more about the Profession....you might be surprised that a substantial knowledge-base has grown outside the auspices of the AMA.
    24- year O.D.
  49. Visionary

    Visionary Medical Retinologist

    Joined:
    12.19.03
    Messages:
    1,198
    Status:
    Attending Physician
    Physician SDN 10+ Year Member
    Nice thread necro. Are you just going to start trolling our forum now? :rolleyes:
  50. Andrew_Doan

    Andrew_Doan Doc, Author, Entrepreneur Moderator Emeritus Lifetime Donor

    Joined:
    10.01.02
    Messages:
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    Location:
    San Diego, CA
    Status:
    Attending Physician
    Physician SDN 10+ Year Member
    I agree with this!

    However, training programs have limited resources. Currently Medicare pays about $100,000 (as I understand it) per surgical resident to train to be eye surgeons. The number of slots are limited. Unless we fix our current financial crisis in medicine, find ways to "generate" patients for optometrists to operate on, AND develop training programs for optometrists (which costs lots of money)... I don't really see optometrists being able to do surgery.

    IF optometrists were able to do surgery, good luck finding a malpractice carrier.

    I sit on the underwriting committee for a large malpractice insurance company. Trust me, it would be near impossible to underwrite a policy to allow an optometrist to operate. There's too much risk. As an insurance company, if I can insure Surgeon A who will be a good risk for my company VS a non-surgeon B who could be catastrophic for my company, who do I pick to insure?

    I am not saying it's impossible... but it is near impossible.

    This said, the optometrists could rally and make their own malpractice insurance company, but during our current financial crisis, it is VERY hard to raise money for something of VERY HIGH RISK.

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