- Joined
- Apr 10, 2010
- Messages
- 2,335
- Reaction score
- 9
Exactly, its not Optometry its YOU. People have been talking down on optometry since its inception.
You're neglecting one small detail. ODs cannot see the volume of patients that MDs/DOs enjoy. We're lucky to get 12 patients through the door each day and even if we billed medical on every one of those patients, you're talking about a bunch of level 3 and maybe a few level 4 office visit reimbursements and scattered tests here and there. It's not going to be a cash cow. MDs/DOs don't have the same problem getting patients in the door. If anything, they sometimes have to close their practices to new patients since they're "full." If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient to see a bunch of EyeMed, VSP, and Optum patients with a few Medicare visits billed to "dry eye" here and there. Wake up, dude - optometry is not medicine, not even close. If MDs were trying to survive on seeing 10-12 patients per day, they'd be in the same boat, but the fact is, they're not.
The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off.
Optometry is, once again, a made up/legislatively purchased profession.
I have a question to the ODs/OMDs: If you over-minus a patient with spectacles and they have a narrow space between the posterior medial iris and the anterior medial lens and they constantly accommodate, can they develop an iris bombe, an increased IOP and cause vision loss? Will this cause any pain or will it be without symptoms?
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2330199/
The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist
The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist
It is probably somewhat job security, but do you expect the average person will be able to convey to an ophthalmic lab the parameters of his/her glasses. A glasses Rx is more a recipe for how to grind lenses unique to the individual to allow them clear comfortable vision. Comparing a spectacle Rx to a medication Rx is apples and oranges. How would you suggest someone go about making their own recipe for glasses? The danger factor is immaterial.
the impracticality of a trial and error system which would be unavoidable if a patient didn't require the Rx. Also without this standard you would be forced to receive your lenses from the guy who did your exam only which would drive up pt costs.
The whole statement was centered around the idea that there is a similar conflict like there is with physicians and Rx meds. The two Rx systems serve completely different ends. THAT was my point
No, I do not expect the average person to be able to handle their own appropriate eyeglasses Rx. That is why I said the last part about the work necessary to make a new set of lenses and the impracticality of a trial and error system which would be unavoidable if a patient didn't require the Rx. Also without this standard you would be forced to receive your lenses from the guy who did your exam only which would drive up pt costs.
The whole statement was centered around the idea that there is a similar conflict like there is with physicians and Rx meds. The two Rx systems serve completely different ends. THAT was my point
This kind of reminds me of the titration that happens when a doc rxs medications. The dosage is trial and error.
wow, you and jason sound like two peas in a pod. Seriously if optometry was only what you describe I would have left long ago. While some of what you say does occur, it is by no means a "universal truth". Your perspective is limited, as is Jasons, by your own experience. I'll be the first to admit optometry has many challenges, but it is and has always been what you make of it (like anything else). If you want to go and spin and grin at the local refractohut then its YOU who is making that choice, if you want the challenge of private practice and offer the full scope of your license then its YOU who is making that choice.
I'm curious why this is, Jason. The optometrists I've spent time with over the years (I actually thought about becoming an optometrist, at one point) all seemed to have fairly low volume relative to your average ophthalmologist. Is this another facet of the oversupply? Are there other factors?
12/day can be a ridiculously busy day depending on the specialty. I dont think you know much about the other side of the fence that you keep trying to compare to...
Otherwise, there is no.distinct difference between peoples so to those saying MDs are greedy and that is the problem with them selling eye ware.... this just isn't a high yield service for MDs. so many other things could be done to pad the bank other than spectacle sales.
The real question I have is: why do glasses require an Rx to begin with? They are arguably less dangerous than even the most benign OTC- if there is a problem just take them off. Not possible w NSAID overdose. The only thing I can come up with that doesn't sound eerily like "OD job security" is the man hours required to make a new set of glasses make it impractical to do OTC sales so you want to make sure you get it right the first time and the patient isn't fiddling with his prescription and making unnecessary work for the optometrist
I don't know any ophthalmologists who would cringe at seeing 12 patients a day. Perhaps one could chime in if I'm off base, but most of them could crank out 12 patients in half a morning without breaking a sweat. I'm not sure what you're getting at here. Obviously, if you're talking about non-eye-related specialties, you're stating the obvious. I'm not referring to those specialties.
I don't know where you think I said MDs are any "greedier" than anyone else so I think you may have been thinking of another poster. What I've said is that MDs, ODs, DPMs, DDS,...all of us are seeing out bottom lines drop. We're all doing things that might be considered "shady." It is not unique to optometry.
Children with inaccurate/inadequate prescriptions can end up with permanent vision loss. Adults running around with inappropriate Rxs can be a road hazard. It's as simple as that.
The statement was in regard to the larger comparison to medical practice in general. However the ophtho clinic at our hospital employs ODs for lenses and MDs for pathology. 12 pts /day is quite comfortable, but they aren't just billing out for vision scans either.
3rd quote: nobody said that improper lensing was inconsequential. See "but you can just take them off"
If your MDs are seeing 12 patients per day, there's something horribly wrong there. If your ODs are seeing 12 patients per day, they're seeing about what the average OD in private practice sees. Most ODs could see double what actually comes through their doors, they just don't have the volume to make that a reality. I'm not sure what you're saying here. I'm arguing that 12 patients per day is too few. You seem to be indicating that it's "comfortable," as if I were saying it was too many. Believe me, 12 patients is not too high of a volume for any OD on the planet unless he's a new 3rd year intern or someone who is fabulously slow.
A 10 diopter myope can take his glasses off and see nothing but shadows and indistinct shapes. A child who has a 2 diopter hyperopic anisometropia can end up with significant vision loss in the more hyperopic eye if left uncorrected. Most kids in this situation have no visual complaints and it has to be found on refraction. I'm not disagreeing with the fact that most adults could get by with an autorefraction Rx, but I can see why there is a legal requirement. As it stands, British Columbia citizens can go online and buy whatever glasses they choose without an Rx and they're not killing each other in the streets. I see your point, but there are underlying reasons why it should be required.
I won't even get into why CLs absolutely should be covered by an Rx. There are too many reasons to list, but most of them lead back to the risk of permanent vision loss if a lens is fit incorrectly and worn for any significant length of time.
care to elaborate?
Personally, I think it has to do with a lot of factors, but mostly that ophthalmologists handle pathology while ODs tend not to handle it as the core of their practice. In most OD practices, patients are there for their routine eye care - primarily glasses and CLs, maybe a red eye here and there. In most MD offices I've been in or worked in, most patients are there for some sort of disease process. The MD is there to treat the problem medically or surgically (or both).
To rustle up a few exceptions where maybe something negative could happen to the patient (like driving without glasses or a kid allowing his eyes to do what they were going to do anyways....) is just grasping at straws.
Yes, I understand you are saying it is too few. Your original post (the one I quoted) said that
"We're lucky to get 12 patients through the door each day"
and
" MDs/DOs don't have the same problem getting patients in the door"
and
" If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient "
To which i said
"12/day can be a ridiculously busy day depending on the specialty"
A few exceptions? That what many laws are in place to protect - the exceptions. It is apparent from your above post that you do not understand high risk refractive error and its role in permanent vision loss or amblyopia in children. I suggest you read up a little on the topic as even the first year OD students could explain why your statement demonstrates incredible ignorance.
You're inserting an argument that really doesn't have any opposition so I'm not sure why you're perpetuating it. The fact that some physicians can be "busy" with 12 patients is completely irrelevant. The big picture is, physicians face their own struggles, but their primary complaints are not related to low patient volume. I had to see an orthopedic surgeon a few months ago and he was booked out 3 months. Dermatology, several months out. Neurology, 3 months or more booked out. Most of the ophthalmologists in my area, even the truly awful ones who's surgical train wrecks I could spot from across the room, are booked out for weeks or months for non-emergent appointments. You'd have a hard time finding a competent MD out there who offers same day appointments for non-emergent care. Not so with ODs. Most can offer same day appointments or a few days out at most. You're missing the big picture here. The point is, MDs face a lot of struggles, no doubt about that, but they are not primarily rooted in not having enough patients. Optometrists cannot say the same. All this other stuff you're referring to irrelevant. If there's some guy in an ICU who's loaded with 12 patients, fine, I think anyone can see that, but it has little relevance to this discussion.
werent you?I'm not sure what you're saying here. I'm arguing that 12 patients per day is too few.
sorry your response was just a very uninformed one, but you are still a student so I dont mean to beat you up about it. To answer in summary its pretty simple, in some cases the wrong spectacle rx can "injure", or cause harm to someones eyes...........permanently. Amblyopia is a perfect case in point. The comparison to a pharm script is the same in this respect (although not nearly as common). That a person could "withdraw" from wearing the wrong spectacles is true.....if they new that it was causing harm, and that's the problem, there is no way for them to tell, and as such is irrelevent.
I dont think you know much about the other side of the fence ...
However to incur any "harm" you need to stick a kid in glasses in which the "correction" exceeds the original refractive error to begin with.
well... a few optomotry students and practicing optomotrists have already weighed in and not said so. It is beside the point anyways. and no, you are missing the big picture. That is why I tried to re-outline it so you could see what brought us from point A to point B.... I am "perpetuating" it because you seemed confused (and still do) about why I brought it up to begin with.
first, because I didn't think your comparison about patients was really that valid in terms of ability to support a practice. If you want to say "ODs dont get enough, and MDs do get enough" fine. That I can agree to. But you centered it around some arbitrary number 12 while outright douching on about 4 other posters simultaneously so I figured I would just let you know your comparison was in error.
Thats really it. Bringing it up again was because the comment seemed to confuse you. I mean... you were there when you posted this: werent you?
wrong again, the ENTIRE premise of requiring professional guidance (ie an Rx) for eyeglasses is pt protection, and has NOTHING to do with "provider protection".
yeah... I hear you say that. I just dont buy it I am not the first (nor the highest ranked) person in here to express those sentiments. jason called the profession legislated, east admitted to a job security angle...
Who will have more pronounced vision loss: 3 children with the same initial acuityYour statement above is absolutely wrong. There is no requirement to prescribe overcorrection to lead to vision loss. I have no idea where you learned that. Lack of correction, overcorrection, and undercorrection can all lead to permanent vision loss in children if the risk factors are there. In fact, in the majority of refractive amblyopia cases I've seen, it's been a total lack of correction that lead to the problem. You're obviously a 1st year medical student. I suggest you read up on the topic, as I said earlier. It might benefit your patients some day.
You're rambling on about nonsense here. Twelve patients per day, for ODs is not anywhere near the limit of possibility, but that's about what the average OD sees in his office. That is the only point I ever made in reference to daily patient counts. It was you who decided to start carrying on about how some physicians can see 12 patients and be "busy." Optometry is a profession in which patients are in short supply per OD. If you want to read into it by making other comparisons which are irrelevant, you're free to do so. MDs, on average, don't have shortages of patients. ODs do. If you fail to understand that, I can't help you.
followed byIn my mind, the difference between the two is that medications, philosophically at least, are not intended to provide the doctor with profit; only to implement his/her treatment plan. Optical sales, on the other hand, is undoubtedly a profit stream, although with all of the changes going on, that's changing too.
You're neglecting one small detail. ODs cannot see the volume of patients that MDs/DOs enjoy. We're lucky to get 12 patients through the door each day and even if we billed medical on every one of those patients, you're talking about a bunch of level 3 and maybe a few level 4 office visit reimbursements and scattered tests here and there. It's not going to be a cash cow. MDs/DOs don't have the same problem getting patients in the door. If anything, they sometimes have to close their practices to new patients since they're "full." If you see 40 - 50 patients per day and you bill office visits for all of them, along with additional testing, you're going to be doing a lot better than an OD who's getting $40 per patient to see a bunch of EyeMed, VSP, and Optum patients with a few Medicare visits billed to "dry eye" here and there. Wake up, dude - optometry is not medicine, not even close. If MDs were trying to survive on seeing 10-12 patients per day, they'd be in the same boat, but the fact is, they're not.
I don't think you understand what it means to be a legislated profession...and if you did you would know that has absolutely nothing to do with glasses prescriptions and "provider protection"
just to clarify...there are cases where a glasses Rx is not essential. A 42 year old healthy presbyope with a plano distance Rx probably doesn't really need an Rx for a +1.50 DS OU readers.
As far as job security goes...5 years ago I would go to my GP to get an allergy Rx and pay 75 bucks for an office visit .now I just go to the wal-mart OTC section and purchase my medication without an Rx. Just curious if you extrapolate that out a little isn't there a job security angle there?
Who will have more pronounced vision loss: 3 children with the same initial acuity
1 goes completely untreated
1 gets treated inappropriately and the correction actually worsens the myopia
1 gets treated inappropriately because the myopia is not fully corrected
expected relative changes in adult visual acuity?
The only thing I was contesting was your assumption that billings are the same per pt. If an OMD were to see 10-12 patients a day, within a full scope of practice and not just vision checks and lenses, that doctor could still support himself comfortably (arguably with plenty of room to grow) on the basis that vision checks and lens sales are at the low end of the spectrum of what an OMD can bill out for. the $/pt goes up for just about anything else so by simple logic alone the income goes up " If MDs were trying to survive on seeing 10-12 patients per day". You are likely correct that they are most of the time seeing more, I was just saying this is irrelevant because the associated dollar value per head is also higher. Thats all... Im a little confused why this was so difficult and why we had to spend so much time on it... let it go man I really don't give a crap how many people specifically each profession sees, the only point of contention was the fallacy in the argument.
Who will have more pronounced vision loss: 3 children with the same initial acuity
1 goes completely untreated
1 gets treated inappropriately and the correction actually worsens the myopia
1 gets treated inappropriately because the myopia is not fully corrected
expected relative changes in adult visual acuity?
your reading comprehension is just phenomenal....
You keep reiterating points that I am not arguing and have explicitly said I have no issue with. You get 12 patients a day? holyfreakingcowzilla! superfun!
You just dont seem to be able to keep this exchange in the context of the thread. We are talking about ODs selling rx lenses. Now, I am going to do what I have done in the last 4 posts and simply address your confusion. I am not on a soapbox "rambling". You are confused as to what my point is. I am approaching half your daily patient load in attempts just to address that, so here we go again... ok?
earlier you said:
followed by
Your argument seems to be that
1) OD Rx IS a profitable endeavor as opposed to MD Rx and that
2) this is OK because this is a significant means by which ODs support themselves because
3)it is an integral part of what the profession is and that
4)Rx sales is NOT a part of what MDs do nor is it a part of their "scope" so
5)the two (OD Rx and MD Rx) are not comparable
on this part we agree.
The only thing I was contesting was your assumption that billings are the same per pt. If an OMD were to see 10-12 patients a day, within a full scope of practice and not just vision checks and lenses, that doctor could still support himself comfortably (arguably with plenty of room to grow) on the basis that vision checks and lens sales are at the low end of the spectrum of what an OMD can bill out for. the $/pt goes up for just about anything else so by simple logic alone the income goes up " If MDs were trying to survive on seeing 10-12 patients per day". You are likely correct that they are most of the time seeing more, I was just saying this is irrelevant because the associated dollar value per head is also higher. Thats all... Im a little confused why this was so difficult and why we had to spend so much time on it... let it go man I really don't give a crap how many people specifically each profession sees, the only point of contention was the fallacy in the argument.
Dude you're probably a cool kid, but as far as your knowledge of treatment and management of amblyopia...well you're just embarrassing yourself. Also you need to talk to some Ophthalmologists (not in academia). They would vomit if they only saw 10-12 patients a day. Your knowledge of billing and coding also needs some work if you think Ophthalmologists can just "bill out" more and make 10 to12 patients per day work in a private practice setting.
I would still like to know you and J-bo's answer to the question on outcomes between the hypothetical patients
You can't participate in an intelligent discussion of refractive amblyopia until you understand what it is and how it occurs. Your above example and your other comments on the topic, demonstrate that you don't understand the basics of the condition. As I've suggested, now for the 4th time, you need to go read up on the subject and you'll understand why your statements are wrong. In particular, there is absolutely no requirement for overcorrection to cause any sort of amblyopia in a child. If you took 5 minutes to read the wikipedia page on amblyopia, you'd stop pushing this point. Your above "comparisons" have little to do with anything related to refractive amblyopia. Please take the 5 minutes. Furthermore, you'd stand to gain a lot by refraining from making assertions about medical conditions with which you are unfamiliar. At worst, it could get someone killed. At best, it might lead to some kid running around with a 20/100 eye due to your lack of understanding of a medical condition related to refractive error.
I'm not trying to beat up on you man..I'm sure you're gonna be a great doc but you should just let this one go
(is he always this grumpy? )
The mechanisms involved in visual development in children seem to all center around the degree of refractive error. The assumption I am running on is that in order to actually cause harm (and I am not talking about failure to avoid a problem. As a provider, "harm" is typically understood to mean "you made things worse") you must provide glasses which increase the refractive error from the baseline. The second assumption is that with further reduced vision the patient would remove the glasses.
A decent argument could be made that failure to properly address vision in the first place and allowing the patient to progress with sub-optimal correction to the point where the errors are permanent could constitute "harm", but again, this gets into hair splitting when the initial point of the post (aside from counter-douching J-bo up there) was to say that a major function of OD Rx is to protect the provider (as was confirmed and eluded to a few times above)
The underlying assumption in the earlier posts was that degree of permanent vision loss is directly related to degree of refractive error.
yes, he feels cheated by his profession. Probably didn't shadow enough or a wide variety of ODs before he went into opto school.
spectargt, let me get this straight you are a medical student who comes to optometry forums to explain ODs about the effects of incorrect prescription. You my friend have way too much time on your hand. Just let it go, I don't think any OD here will be continuing this debate with you any further, well at least in a way you would like to.