Orals Bill passed in Florida

[Shnurek]

Wooo! 48 states down, 2 to go. C'mon New York and Massachusetts. Get with the times.

Florida Senate Panel Approves Expansion Of Optometrists' Power To Prescribe Drugs.

The Jacksonville Business Journal http://mailview.bulletinhealthcare.com/mailview.aspx?m=2012021301aoa&r=5673680-7c08&l=045-6b6&t=c(2/10, Saunders, Subscription Publication) reported, "In a deal tying two controversial health-care issues, a Senate committee Thursday approved a plan that would put new restrictions on medical-malpractice lawsuits and expand optometrists' power to prescribe drugs." The deal "would provide medical-malpractice legal restrictions that the" Florida Medical Association (FMA) "has made a top priority," and "in exchange, the FMA agreed to go along with allowing optometrists to prescribe some oral medications." Rebecca O'Hara, vice president of FMA's governmental affairs, said, "These provisions (of the amendment) live together and die together."

---

Members don't see this ad.

 

[Visionary]

Can't recall the last time I prescribed an oral med. Maybe Diamox for IIH? Even oral steroids for GCA or autoimmune diseases are usually prescribed through the PCP or Rheum, rather than me. Kind of useless scope expansion, IMO. But, hey, congrats.

 

[q1we3]

. Kind of useless scope expansion, IMO.

It is not necessarily about how many times an optometrist will actually prescribe a oral drug. It is about given the right/freedom to use every bit of your optometry school training, which isn't short or inexpensive. Plus, it helps improve the image and perception of what Optometrists are really capable of dealing.

 

[The Doctor]

I wish I knew more so that I could intelligently join this discussion. It does not seem unreasonable to me that optometrists could prescribe an oral medication active in the eye if the treatment was immediately necessary such as pain medication (though I'm not sure orals would be used for this) or for a minor self-limited condition where the diagnosis is clear and with close follow-up. Those with further training could answer better to that question than could I. I agree that medications for a long treatment course or with more systemic effects such as steroids could be dangerous. Even after 5 years in medical school I would feel cautious managing a steroid regimen with the potential for psychosis, endocrine effects, immunosuppression/infection, etc. Doing this without training in whole body physical exam, basic psychiatry, etc seems unwise.

I suspect that with four years of schooling dedicated to the eyes optometrists are capable of more than their current scope, but it also seems clear that there should be some sort of limit. I wish that the leaders of both optometry and ophthalmology could communicate to come up with some sort of permanent consensus statement to define the role and ultimate purview of each profession. The constant legislative challenges seem to reflect the goals of a minority of the optometry profession, and I have heard that many of these scope expansions are generally not adopted with any widespread frequency. I feel like the enmity that is generated is counterproductive to patients and to each of our professions.

I feel like one of the greatest strengths of the American healthcare system is its relative standardization. If you see an M.D., for the most part you can feel relatively confident in their competence; they've passed board exams, attended an ACGME accredited residency, likely passed board exams in their specialty. It sounds like optometry also has similar step 1,2,3 exams. As such, I personally have always felt comfortable trusting my basic eye health care, refraction, and contact lens fitting to an optometrist. I'd probably even rather go to an optometrist for this service. What I'm afraid of for optometry and ophthalmology in general is that these legislative scope expansions generate confusion and a lack of standardization. Being an optometrist in one state then means something slightly different than in another state. Even within the same state, one optometrist then may be practicing with a different skillset or active practice pattern than another optometrist. I fear that credentialing then becomes an issue and it becomes more difficult to have faith in any particular practioner's abilities (and they may very well be qualified, but without a lack of standardization it's really impossible to say).

Ultimately, this uncertainty may hurt both optometrists and ophthalmologists. Historically optometrists have been the experts in basic eye care, vision screenings, glasses and contact lens fittings - I feel like these are very important services and I for one would like to have you guys stick around to do that. It may be that by trying to change the scope of the profession too much (for example, adopting scapel surgery) you may take the profession too far from its roots and lose your identity and patient base. Just some thoughts rambling around my head based on what I've heard and not intended to insult the abilities of anyone. Feel free to chime in and respond.

 

[Shnurek]

It does not seem unreasonable to me that optometrists could prescribe an oral medication active in the eye if the treatment was immediately necessary such as pain medication (though I'm not sure orals would be used for this) or for a minor self-limited condition where the diagnosis is clear and with close follow-up.


I wish that the leaders of both optometry and ophthalmology could communicate to come up with some sort of permanent consensus statement to define the role and ultimate purview of each profession. The constant legislative challenges seem to reflect the goals of a minority of the optometry profession, and I have heard that many of these scope expansions are generally not adopted with any widespread frequency. I feel like the enmity that is generated is counterproductive to patients and to each of our professions.

Thank you for your intelligent and humble response. Many individuals unlike yourself maintain anonymity with us and it is indeed counter-productive. We are here, we have overlapping scopes of practice and people need to get with the times. Its good to accept it and work together. Healthcare is changing and as any good businessman will tell you, "If you do not change you die."

Also, just to clarify there was a survey conducted where the results stated that 30% of optometrists would do a 2 year surgical residency if they could.

ODs can prescribe narcotics in 36 states and they are mostly oral analgesics so yes it is not unreasonable in most places in America for ODs to do that.

Kind of useless scope expansion, IMO. But, hey, congrats.

How about Acyclovir for Zoster keratitis? Really useless when the dendrite is actively expanding on a person's eye. I know personal stories of this and by the time they reached an ophtho in the emergency room they didn't believe the patient because the ophtho said they just slept in their contacts. This is of course anecdotal but we are using stories like this to get orals in NY as well.

 

[Tippytoe]

An oral antibiotic for pre-septal cellulitis is about the only oral med you will ever prescribe an an OD ---- maybe an antiviral for zoster (but it will usually be Rx'd by the PCP who referred it to you). An OD could start the course along with topical antivirals but it doesn't happen much and either way you're going to send the pt to their family doc due to the systemic nature (or more likely a PA with less training than you).

Other than that, I can't think of any oral meds that are really used in routine eyecare in an optometry office. To tell you the truth, the only 2 'medicines' you need to learn to practice optometry is TOBRADEX and Pred Forte.......(and which artificial tear drop the patient asks you is better to buy at Walmart.....which is whatever samples the company happen to mail you that month). Which is why if optometry even needs to exist it should be an associates degree. I can work all day long with one hand and half my brain. Really I have to think harder to help my 4th grader do her homework than I do see patients. "

"1 or 2, and here's some Refresh tears to try. See you next year (even though you don't really need to be seen for 4-5). Next!"

How much income does the aforementioned "oral" treatments make me (and I treat a lot of red eyes) in a year.............maybe $1000 added to the practice gross----- if they have good insurance. (That's 0.0025% added to the gross income). I can also do injections. Know how much money that makes in my 'medical' oriented practice--- maybe another $1,500/year? About the only thing you will inject in optometry is a chalazion (at least they are common). That's it. I can not think of any other eye injection that needs to be done outside of surgery.

Not a big WIN really. Just more political back-patting overall. But since optometry is an independently licensed profession, we really should be calling our own shots without having to ask permission.

Don't worry, as soon as we start blinding or killing people, it'll be all over. So the fear tactics used by organized ophthalmology and medicine really aren't needed. Big waste of your money. Unless it's not about patient safetly.............. HMMMmmmmmmmm..........

Of course it's not. It's ALL about money. Always is and always will be. It's why we don't want opticians refracting.

I'm not a big fan of Optometry..........and I'm not a hypocrite either.

 

[optsuker]

I know you still have a few years, but as of now, the only "liberal" optometry scope is in OK. Even with the KY law, there has not been full implementation, and it will probably take longer before that filters down to any residency training. Of course, regardless of training, you will still be limited by where you practice, as you well know. I'm really not trying to start anything, so let's not get into a p**sing contest. Just something to think about.

Can't recall the last time I prescribed an oral med. Maybe Diamox for IIH? Even oral steroids for GCA or autoimmune diseases are usually prescribed through the PCP or Rheum, rather than me. Kind of useless scope expansion, IMO. But, hey, congrats.

Love this guy's condensending, passive-aggressives posts.

I've been prescribing oral meds for about 20 years. It's not every day, but often enough to be a valuable tool in treating my patients. Anti-virals, antibiotics, and occassionally, pain medication and steroids. All have a role in optometry.

 

[Meibomian SxN]

Love this guy's condensending, passive-aggressives posts.

I've been prescribing oral meds for about 20 years. It's not every day, but often enough to be a valuable tool in treating my patients. Anti-virals, antibiotics, and occassionally, pain medication and steroids. All have a role in optometry.

I agree. Its not the usual prescription that I write but when I need an oral antibiotic or pain med, I do not feel like calling primary care etc. I have started Rxing more low dose doxy Rx's lately but outside of that the rest is a rarity.

 

[Visionary]

Love this guy's condensending, passive-aggressives posts.

I've been prescribing oral meds for about 20 years. It's not every day, but often enough to be a valuable tool in treating my patients. Anti-virals, antibiotics, and occassionally, pain medication and steroids. All have a role in optometry.

I can see how it might come across that way. Sorry. Wasn't really trying to start anything. Shnurek tends to bring out the worst in me. Oh, well. I guess my point was more about organized optometry focusing efforts on something that's so infrequently used, as multiple of your brethren have echoed. I can count on one hand the number of orals I've prescribed in the last 3 years. HZO patients typically come in from their PCP or an ICC already on antivirals. They just want me to look for/monitor eye involvement. I've never prescribed oral pain meds outside of oculoplastic/vitrectomy/SB surgery as a resident. I've probably prescribed Doxy for blepharitis more than anything.

Of course, as has also been said, it's more about you having ultimate control over how you practice, and I can appreciate that, even when not completely agreeing with it. While, as Tippytoe mentioned, there is a money aspect, I (personally) don't feel it's about money. Heck, I'm not worried about any optometrists (or other ophthalmologists, for that matter) stealing my patients. For me, it's about my 8+ years of post-bac training meaning something. Why should you be able to obtain the same privileges I have with half the post-bac training? It's the same reason IM docs are pissed at the prospect of PAs and NPs practicing independently as physicians. Yes, legislation like that elevates your field, but at the expense of devaluing ours. Surely, you can understand that view (e.g., opticians). I'm going to don my flame ******ant suit and await the inevitable.

 

[Meibomian SxN]

....For me, it's about my 8+ years of post-bac training meaning something. Why should you be able to obtain the same privileges I have with half the post-bac training? It's the same reason IM docs are pissed at the prospect of PAs and NPs practicing independently as physicians. Yes, legislation like that elevates your field, but at the expense of devaluing ours. Surely, you can understand that view (e.g., opticians). I'm going to don my flame ******ant suit and await the inevitable.

 

[Tippytoe]

Why should you be able to obtain the same privileges I have with half the post-bac training? It's the same reason IM docs are pissed at the prospect of PAs and NPs practicing independently as physicians. Yes, legislation like that elevates your field, but at the expense of devaluing ours. Surely, you can understand that view (e.g., opticians). I'm going to don my flame ******ant suit and await the inevitable.

Visionary, while you are here, could you please explain to me (and others I assume) the difference between a 'medical retinologist' vs. a 'surgical retinologist'?

I've seen those terms but never really understood the difference.

 

[Visionary]

Visionary, while you are here, could you please explain to me (and others I assume) the difference between a 'medical retinologist' vs. a 'surgical retinologist'?

I've seen those terms but never really understood the difference.

Bascially, I take care of vitreoretinal disease with topicals, injectables, and lasers, but I do not do vitreoretinal surgery. I did a 1 year medical retina fellowship following residency. Most (decent) surgical fellowships are 2 years. Fact is that 85-90% of retina nowadays is medical anyway. I was on the older, non-traditional side, so I decided that I couldn't justify the additional training. Less stress, anyway. No after hours/weekend RDs, endophthalmitis to deal with.

 

[The Doctor]

Do you feel that there is any particular value in doing a discrete 1 year medical retina fellowhip (and then maybe a 1 year surgical fellowship) as opposed to a two year traditional program? I know of one person who has arranged their fellowships this way, but I understand that it's not particularly common. I'm strongly and particularly interested in medical retina diseases, but could envisage myself wanting to pursue surgical training as well.

 

[Visionary]

Do you feel that there is any particular value in doing a discrete 1 year medical retina fellowhip (and then maybe a 1 year surgical fellowship) as opposed to a two year traditional program? I know of one person who has arranged their fellowships this way, but I understand that it's not particularly common. I'm strongly and particularly interested in medical retina diseases, but could envisage myself wanting to pursue surgical training as well.

Not to derail the thread, but I don't know of anyone who would purposely arrange it that way. Most people who do medical then surgical do so because they failed to match into surgical the first time and scrambled into medical (or another such as uveitis, pathology, etc.). Would be better to do a straight 2 year surgical fellowship. Most of the 1 year surgical fellowships are poor volume. With the 2 year, you typically have a medical emphasis the first year, but still operate some. You need all the volume you can get.

 

[hello07]

thumbs up for oral bill passing in Florida. I wonder how much more difficult it will now be to obtain a Florida license -OD. Florida along with NC back in my days were 2 of the most difficult states to get a license. You have to know your pathology/ ocular disease and well-back then believe me "politics "played a role. Less than 50% passed.
If you're out of OD school more than 5? yrs- good luck passing florida boards. Impossible to slim......................


Congrats fellow colleagues!

 

[Shnurek]

thumbs up for oral bill passing in Florida. I wonder how much more difficult it will now be to obtain a Florida license -OD. Florida along with NC back in my days were 2 of the most difficult states to get a license. You have to know your pathology/ ocular disease and well-back then believe me "politics "played a role. Less than 50% passed.
If you're out of OD school more than 5? yrs- good luck passing florida boards. Impossible to slim......................


Congrats fellow colleagues!

Good, keeps the state from becoming over-saturated. Younger ODs are coming out from school more knowledgeable every year and should have the privilege to practice there if they wish. I'll do what my friend is going to do. Get licensed right after graduation just in case I ever want to practice there.