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How does the rest of the world see without ODs?

Discussion in 'Optometry' started by Tippytoe, 02.27.12.

  1. Tippytoe

    Tippytoe

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    Just for those of you that aren't aware, large areas of the planet do not have optometrists. Yet oddly we dont hear about a bunch of blind people walking around. And I don't mean rural Africa. I mean up-to-date places like the United Kingdom and most of Europe.

    From Wikipedia:

    "... in Germany, optometric tasks are performed by ophthalmologists and professionally trained and certified opticians."

    " In France, there is no regulatory framework and optometrists are sometimes trained by completing an apprenticeship at an ophthalmologists' private office.

    In Argentina- Anyone holding a Bachelor's degree may register as an optometrist after completing a written exam.

    In Australia, Ireland, Russia and Columbia, Spain and others optometry is a bachelors degree only.

    I'm sure there are more. Which leads me to my question:

    WHY DO WE NEED DOCTORS OF OPTOMETRY HERE WHEN MOST OF THE WORLD DOES JUST FINE WITH OPHTHALMOLOGIST AND OPTICIANS? Just something to think about.;)

    Could it simply be that a bunch of guys needed a job back in early 1900's and decided to measure eye glass prescriptions and then paid legislators over the ten decades to create a made up profession and expanded it over the years? Just saying...........

    * Of course, most of those bachelors degree optometrist do not practice full-scope optometry care like we do here in the states (ie. no diagnosic or dilation drops and treatment eye drops).
    Last edited: 02.27.12
  2. Visionary

    Visionary Medical Retinologist

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    Well, now you've gone and done it.
  3. Shnurek

    Shnurek

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    Because this is America and we do things our way. From a neuroplastic viewpoint humans learn better at a younger age. Our world is exponentially becoming increasingly complex. Therefore early specialization is the future. Being placed in an ophthalmology residency knowing barely anything about the eye at age ~26 is not the best solution, in my humble opinion.
  4. Jason K

    Jason K

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    Why is being placed in an OD program at 22....knowing virtually nothing about the eye any better? Any lack of knowledge by a 1st year ophthalmology resident is more than made up for by the end of their 2nd year. Trust me, Shnurek - you take a 2nd year ophthalmology resident and put him/her up against even the best 4th year OD student or resident and there will be nothing but a short white coat and some dust left over where the OD-in-training was standing. Sorry, dude - I've worked with OD and MD interns and residents and that's the way the chips fall.

    Most knowledgeable ODs practice at about the medical level of an end of 2nd year resident ophthalmologist. Are there some ODs that fall outside that range? Sure, Paul Karpecki could probably go toe-to-toe with an MD corneal specialist diagnostically and do pretty well. The average joe OD out in a "medical" optometry practice would be decimated. When you're in an MD residency, you're going to see thousands upon thousands more patients than you would see in an OD program, working 18 hour days, 6 days a week....for three solid years. The training they get is nothing like ours.....it's high volume, high complexity, and nonstop for 3 years. If you think MDs in the eye world are at some disadvantage because they started their residencies with little knowledge of the human eye, you're crazy.

    OD students pay hundreds of millions of dollars each year to their schools in tuition. Do they get a fair product in return? Go talk to a couple of MD interns and ask them how many patients they see in a shift. Four? Five? A busy OD intern will examine 3-4 patients at an internal site. If an MD program provided abysmal numbers like that, I doubt they'd be accredited. Only optometry is ok having you released into the world having only seen a few hundred patients before graduation. Optometry is screwing its students before they even get out of school......and you guys don't even know it.
    Last edited: 02.27.12
  5. Shnurek

    Shnurek

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    Assuming 1 year less college, 4 years less medical school and 1 year less intern/transitional year then it would be age 20 for opto vs. age 26 for ophtho. These are assuming usual minimums and not special cases where people skip grades. And both having a pre-med background which they do. There is a reason why dentists are so successful and why European medical schools start at age 17-18.
  6. thecgrblue

    thecgrblue Enjoyin' the journey

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    In Italy the opticians generally have their shop on the ground level and if you need to get a prescription they'll take you upstairs and do the refraction. Any conditions go to the equivalent of an ophtho.

    Med school in Italy is 5-6 years. Afterwards, if they want to do GP they have 3 years additional training or if they want to do anything else it is anywhere from 4-6 years. Not much difference.
    Last edited: 02.27.12
  7. myhandsarecold

    myhandsarecold

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    Ophthalmology residents are usually the top 1-10% of each graduating MD class, these are the cream of the cream of the crop. I only go to ophtho for eye care.
  8. Visionary

    Visionary Medical Retinologist

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    Appreciate your patronage, but I have to stand up for my optometrist colleagues on this one. Yours is a pretty broad generalization. I know many ophthalmologists who were not in the top 10% (or even close). Furthermore, there are some ophthalmologists to whom I wouldn't send my worst enemy. There are also some optometrists to whom I'd trust my own mother's care. There are good and bad apples on both sides.
  9. Shnurek

    Shnurek

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    Top 1-10%? These scores say otherwise: http://farm3.static.flickr.com/2298/2415481402_b7926f4a2b_o.jpg Ehhh many ophthos have their GED techs do the most basic procedure of eye care. A refraction. Heck, some ophtho offices still use plus cylinders lols. But to be impartial (its hard for me) there are optometrists too that suck at refracting. (I don't know how they survive lol)
  10. myhandsarecold

    myhandsarecold

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    Hard to attract people into ophtho 'cause of the lower salaries and too competitive. The 9 specialties on that list with the high Step 1 are usually the top 10-15% with the transitional year overlapping with rad onc, rads, derm, ophtho so it's a pretty small group. Ophtho students made up 411/17000~, <3%, last year and the scores are up to 238.
  11. Tippytoe

    Tippytoe

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    I never said ODs don't do good work. Quite the opposite. We do a very good job on the whole. I'm just questioning the need for a 'middle' profession.

    It will be similar when dental hygienist get to practice independently (sooner or later). They will act as a 'cleaner and screener' and refer to a dentist when a problem arises. Is that needed?? Might be a little cheaper to get a cleaning.

    Basically an parallel profession does lower prices for the general public. But it will make going through all the hard work and risk to become a doctor not worth the trouble eventually. Of course MDs don't care about dental hygienist moving in on dentist's turf become there are no 'tooth' MDs. There is no outcry that hygienist are going to be killing people like they have been saying about ODs for 50 years.

    Soon there will be no more family doctors. PAs and NPs will take that role. 'See, treat, refer' will be the motto.

    Progress I guess.
  12. Shnurek

    Shnurek

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    Yup, in California dental assistants just got a law passed saying that they can clean teeth, extract, make dentures without the supervision of a dentist. Check out the dental forums.
    The CRNAs and AAs are doing the anaesthesiology jobs.
    NP/PAs for internal med/fam medicine and don't forget DNPs!
    Also, Podiatry is moving up the leg in their scope of practice, physical therapists got a doctorate recently, chiropractors are calling themselves physicians and they use xrays now to objectively prove misalignments and the orthopaedic surgeons are not happy about all this.
    Psychologists are getting prescription rights and psychiatrists are up in flames.
    Audiologists making otolaryngologists nervous.

    This trend is not unique to opto/ophtho. And it is progress because back in the day specialty residencies like orthopaedic surgery and radiology were easier to get into than internal medicine. Now its the exact opposite. MDs are being pushed towards specialization.

    Perhaps due to no increased funding to create new residencies and not many new schools opening up. Perhaps due to residency hour restrictions, other professions step in to take over the slack. Perhaps due to the limits of the human mind that we can only really be the masters of one specialty and we must work together to give the best care for the patient. Either way they'll still be at the top but it is a lot more competitive now and they will be more managerial and extremely specialized.
    Last edited: 02.29.12
  13. q1we3

    q1we3

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    completely agree:thumbup:
  14. Jason K

    Jason K

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    Shnurek, you're off making assumptions again. I don't know where you heard that dental assistants are doing unsupervised extractions, but here on planet Earth, that's absolutely untrue. Dental assistants can't do much of anything unsupervised, let alone surgery. Please check your facts.


    I'm sure the ENTs on this forum got together and shared a good laugh about this comment. I highly doubt they're "shaking in their boots" over audiologists taking over their heavily surgical specialty......oh wait a minute, ENTs are surgeons and audiologists are.....audiologists so they probably don't care. We could saturate the US market with 1 audiologist for every optometrist and there would probably be little effect on the average ENTs practice.
  15. pinipig523

    pinipig523 I like my job!

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    I think with advanced training, they can.

    https://www.revisor.leg.state.mn.us/bin/bldbill.php?bill=S2895.0.html&session=ls85

    Kinda scary.

    It's been in the MD field as well... but in EM - a PA can't do what MDs do. Fast track stuff, yes, but resus? No.

    These mid-levels are creeping up and about. This might be a bigger issue in the future. Watch out for your opticians.
  16. Jason K

    Jason K

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    Dental assistants are not the same as dental hygienists. Even that said, there is no way any dental assistant or hygienist would be licensed to independent extractions. Even ADHP (Advanced dental hygiene practitioner) can't do it, but they can do injections and some other procedures.
  17. thecgrblue

    thecgrblue Enjoyin' the journey

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    My wife is a dental assistant and she will be the first to tell you that they pose ZERO threat to a dentist. 10 weeks training vs. 4 years minimum post-bac...c'mon!

    How on earth would an audiologist encroach on ENT?! I can't even write more without throwing my hands up in the air and saying, "Seriously!?"
  18. Jason K

    Jason K

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    No kidding - I have a several palm prints on my forehead after reading about "dental assistants taking over dentistry" and "audiologists taking over otolaryngology."

    I hear optometric assistants are going to be getting rights to do unsupervised enucleations while blindfolded....you know, for the patient who wants that daring enucleation, but doesn't want to bother with driving an hour to see a surgeon. Oh wait, that's ridiculous. :laugh:
  19. thecgrblue

    thecgrblue Enjoyin' the journey

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    Actually Walmart is lobbying to get the ability to install a machine operated by just a tech that can perform enucleations, it will go next to the dental implant machine that is run by a dental assistant. OMDs are FREAKING OUT OVER IT!
  20. Shnurek

    Shnurek

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    Encroachment issues as a whole:
    http://elephantcircle.net/wp-content/uploads/2011/01/ASHA-PPT-on-SOPP-and-Data-Series-A5.pdf

    Audiologists:
    http://www.pamedsoc.org/MainMenuCategories/Government/2009-10/Audiology-bill.html
    http://www.audiology.org/advocacy/grnews/Documents/AcademyResponsetoAMASOP.FINAL.pdf

    Advanced practice dental assistants/hygienists:
    http://forums.studentdoctor.net/showthread.php?t=502094
    http://www.startribune.com/featuredColumns/106489988.html
    OK, so I overstated their scope of practice a bit because some posters were freaking out on the dental forums and made false statements:
    But the main point of my post still stands and nitpicking at it doesn't really put a dent into it.
  21. Dr Colin K Chan

    Dr Colin K Chan Toronto Optometrist

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    Couple of things.
    1)in the countries that don't have ODs, like you said, they have ophthalmologists doing health AND refraction plus opticians doing what they do best. ppl are still served what they need. here, most ophthalmologists only deal with specific problems so our ODs here serve as the primary care of the eyes. it's pretty much the same services the community receive, except it's done by different groups of people.
    2)u mentioned UK? they do have optometrists there and they've been dealing with pharmaceutics long before we have over here.
  22. jc211

    jc211

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    About China, There is no Optometist in China, any one who even graduate from middle school can prescribe glasses.
    That cause a problem that my accommodative insuffiency and convergence excess from 15 years old was not being able to diagnosis and treated by Vision Therapy, which influenced a loooooooot of my life. MDs don't do VT and Binocular in China.
    I think US is much more better in this area.
  23. Shnurek

    Shnurek

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    :thumbup:
  24. Commando303

    Commando303

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    I agree optometry is a somewhat redundant profession on paper, but, practically, in the United States, the field covers a large area of primary eye-care that is not heavily touched by either ophthalmology or opticianry.

    Personally, I feel eye-medicine ought to be structured vertically, such a person is allowed to work her or his way to whatever rung of practice she or he would be comfortable occupying; it's senseless one's education and skills are effectively meaningless if one later decides to expand one's professional boundaries.
  25. Shnurek

    Shnurek

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    :thumbup::thumbup:
  26. Visionary

    Visionary Medical Retinologist

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    So, opticians should be able to comp out of certain aspects of optometry school and optometrists should be able to comp out of certain aspects of medical school/residency? That sounds like a great idea. :rolleyes:
  27. Shnurek

    Shnurek

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    Personally, I wouldn't mind opticians that have been working for decades to use auto-refractors to spit out prescriptions for cheap people that don't care about their visual quality (they just passed this law in British Columbia for patients ~19-64 years of age) as long as optometrists were allowed to enter ophthalmology residencies. Maybe only making up 5-10% of the slots?

    Right now what is it?, ~400 allopathic ophthalmology residents matching every year and how many DO? So if the government would fund 20-40 spots a year for star ODs that would be nice.

    I don't know how to make it work. We'd have to look at oral and maxillofacial surgery and how the dentists developed that pathway. I think they just developed it themselves and didn't enter ENT residencies. Seems like ODs will have to do the same.
  28. Visionary

    Visionary Medical Retinologist

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    For as obsessed as you are about obtaining ophthalmologist privileges, why didn't you just take the traditional route of medical school and ophthalmology residency, rather than entering optometry school and hoping for a short-cut to appear? I mean some decide later on, when it isn't practical to go back, but you have been talking about this since before you started. I have a feeling you're going to end up disappointed.
  29. Shnurek

    Shnurek

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    Personally, I wouldn't really make a fantastic eye surgeon because I have some minor visual deficits. I just think it makes more sense to learn from a younger age directly without going through the inefficient hell that is medical school. I'm doing this mostly for the sake of my colleagues that are out in practice for 10, 20, 30 years and are underutilized.

    I mean there is already a short cut. Its called moving to Kentucky/Oklahoma. I just want to help proliferate that.
    Last edited: 03.28.12
  30. swtster

    swtster ICO, Class of 2016

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    Just an aside -- the University of Melbourne now offers a Doctor of Optometry program in place of the bachelors and they're hoping to be accredited in North America by 2015, at the earliest.
  31. Jason K

    Jason K

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    Shnurek, I haven't asked this in a while, but are you high.....AGAIN? Why on this planet should there be any need for a surgical residency program, designed for medical school graduates, to accept even a single OD?

    The parallel between dentists and OMFS programs is not valid. Dentists are trained as surgeons during dental school. They do minor non-invasive procedures all the way through invasive dental procedures. Optometrists are not trained as surgeons. We don't have the systems in place to even begin to do that. I really don't care that OK and KY are blasting lasers at patients like a Phantom Menace screening so those ODs can feel like they sat at the "cool kids" table - it hardly qualifies those states as providing surgical training. That's like saying that someone is trained to drive a formula 1 car because they can pilot their grandmother's hyundai sonata to the corner market and back.

    Finally, and perhaps most importantly, you need to pull yourself out of the mindset that the world revolves around any individual practitioner's needs. It's not about whether you or any other OD would LIKE to be trained as a surgeon (although I suspect most do not), it's about whether or not there is any NEED for ODs to undergo this sort of training. There isn't. The US has plenty of ophthalmologists already. What possible motivation is there to accept ODs into OMD residency programs? Is it to make you happy? There is no reason to do so - they're all set.

    Just because there are far too many ODs doesn't mean that someone else has to let us into their life boat. We blew ourselves up to massive proportions. It's not up to someone else to bail us out. Heck, Obama's big on bailouts. Maybe ODs should approach him and see if he'll do a tax-payer funded bailout for the entire optometric profession. We could all be funneled into performing some sort of unnecessary, government-mandated service to the public. Maybe something loosely related to the visual system. It would be fantastic.

    As I've said before, just because you want something to be true or to happen, doesn't mean it makes sense or that it's valid. Funneling ODs into ophthalmology programs makes as much sense as allowing "urinary-tract-fascinated" DVMs into urology residencies.
    Last edited: 03.28.12
  32. thiaeyemd

    thiaeyemd New Member

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    We have gone down this road before so I wont reopen it, but I think it is well explained and discussed why going to medical school is important if you are going to operate on patients. Last month I had a patient who during a DCR was discovered to have a meningoencephalocele. I discovered it and recognized it not because of my ophthalmology residency or oculoplastics fellowship but because of medical school training during neuro-anatomy and neurosurgery rotations. This was also used when two weeks ago a colleague recognized that a patient had ITP on the table during retinal surgery. The broad based education of medical school is necessary for surgery. When we talk about different procedures that the general ophthalmologists and optometrists talk about doing (lasers, whatever) one can say what they want but if we are talking surgery, real surgery, you need a broad based education. Any surgeon, general, me, neurosurgeon, OMFS, will tell you that.
  33. thecgrblue

    thecgrblue Enjoyin' the journey

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    :corny:

    It actually used to be called MENT. Then this small group in Oklahoma was like, "F you guys. We hate ENT and are taking the M for ourselves." Thus, the birth of modern dentistry. OMFS was actually the love-child of a cardiothoarcic surgeon and a neurosurgeon. They got all boozed up one night and almost 10 months later...BOOM. When he grew up, mom and dad tried to get junior to follow their respective careers. Not wanting to disappoint either he decided to split the difference and created OMFS.

    So, if we want to model dentistry...we need a neurosurgeon to knock up an OD and have a thing on the side with an ENT. I think we could have a chance.
    Last edited: 03.28.12
  34. bobbio

    bobbio Lurker

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    :thumbup:

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