Scope of practice opinions...

[POJO]

I disagree with your comments. If I diagnose diabetic retinopathy, you can be damn sure that I should (and do) receive the same reimbursement as an ophthalmologist. I dont know what an NP does (I hope its not eyes), but it does not compare to what I do (which is eyes). My diagnosis will be accurate and I will be paid for it. Are you a resident, because I thought this was pretty common knowledge among "real" world practitioners.

I was asking not what is happening but why should optometrists get paid the same as an ophthalmologists for the same diagnosis for the same procedure?

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[acurarte]

Dear PBEA,

I'm not claiming "superiority" but I have to wonder, does your opinion on ODs scope of practice reflect an OD training 40 or 50 years ago, or does it reflect the training that I received? If it reflects the "older" model of optometry then we will never agree. And we will never get to those fargin reimbursement concerns.

My opinion of an acceptable scope of practice is really quite reasonable and probably more liberal than a lot of ophthalmologists. For purpose of insight, yes, my father has been practicing for close to 40 years and has really been quite progressive. He owns an large office with 7 lanes and a surgical center housed under the same roof which he rents out to an ophthalmology group. He has manged preoperative and postoperative care for his patients including PKE, PKP, LASIK, RK etc. He owns an OCT, VF, fundus camera and many other gadgets and remains quite up to date. God forbid, his techs even know how to refract. His practice is mostly geriatric and he treats a lot of disease because of this. I'm not entirely sure, but I think he was one of the largest OD prescribers of glaucoma meds in the state. He has sat on the board of his state association and was the president when medication rights were awarded to the OD's in his state. Is he old school? Probably, because he remembers his roots. He also knows when to refer and understands his limitations. This is a sign of a great doc whether MD, DO, DMD, DDS or OD. Perhaps we can get to those fargin reimbursement concerns after all?

The optometric community needs to agree amongst themselves on a scope of practice at a national level. Once this occurs, then perhaps both sides could meet and come to an agreement. Yes, there will need to be compromise on both sides. I'm not sure it will ever be possible, but I would like to think so because I for one think it is rediculous that we spend so much money fighting over this issue.

Another issue has to do with the lobbyists. I think they are partially responsible for perpetuating the whole thing because as long as the fight exists, they have a job. Again just my opnion but someting to think about.

 

[VA Hopeful Dr]

I was asking not what is happening but why should optometrists get paid the same as an ophthalmologists for the same diagnosis for the same procedure?

I was under the impression that Medicare paid the same for everything, they don't care who does it.

 

[VA Hopeful Dr]

The optometric community needs to agree amongst themselves on a scope of practice at a national level. Once this occurs, then perhaps both sides could meet and come to an agreement. Yes, there will need to be compromise on both sides. I'm not sure it will ever be possible, but I would like to think so because I for one think it is rediculous that we spend so much money fighting over this issue.

Another issue has to do with the lobbyists. I think they are partially responsible for perpetuating the whole thing because as long as the fight exists, they have a job. Again just my opnion but someting to think about.

A national scope of practice is, or at least was as of Spring 2005, on the AOA's to-do list. Trick is, that has to be done on a state-by-state basis, and some states are more friendly to ODs than others.

As a medical student from an optometric family, I completely agree with you that moderates on both sides need to just sit down and hammer this nonsense out once and for all. Sadly, I don't see that happening anytime soon. Too much bad blood on both sides these days.

 

[PBEA]

I was asking not what is happening but why should optometrists get paid the same as an ophthalmologists for the same diagnosis for the same procedure?

Because we (OD and OMD) do the EXACT same thing. We follow the same protocols, use the same methods of examination, up until surgery ODs and OMDs are basically identical. Whether you can accept that fact remains to be seen. I wonder, does your question reflect your personal opinion, or have you been "lead" to believe that by others?

 

[Ben Chudner]

I was under the impression that Medicare paid the same for everything, they don't care who does it.

This may be changing in the near future. Part of the calculation of what Medicare will pay for a particular CPT code is based on malpractice expense. Ophthalmology has made the argument that since their malpractice rates are higher than ours, that should be taken into account when calculating payments.

 

[Ben Chudner]

I was asking not what is happening but why should optometrists get paid the same as an ophthalmologists for the same diagnosis for the same procedure?

Why shouldn't optometrists get paid the same as ophthalmologists for the same procedure? Let's take for example a superficial corneal foreign body removal. What will the ophthalmologist do differently that would justify a higher payment? You may make the malpractice argument, however, I would counter by saying that the malpractice rate for an ophthalmologist is not higher because of foreign body removals, and therefore that procedure should not have a higher malpractice component in the payment calculation.

 

[VA Hopeful Dr]

This may be changing in the near future. Part of the calculation of what Medicare will pay for a particular CPT code is based on malpractice expense. Ophthalmology has made the argument that since their malpractice rates are higher than ours, that should be taken into account when calculating payments.

That's why a 15 minute cataract pays $600 while 3 comprehensive exams (assume 5 minutes each) pay a grand total of $360.

I can see where ophthalmology is coming from, but the surgery reimbursement should make up the difference, not the exam fees.

 

[Ben Chudner]

That's why a 15 minute cataract pays $600 while 3 comprehensive exams (assume 5 minutes each) pay a grand total of $360.

I can see where ophthalmology is coming from, but the surgery reimbursement should make up the difference, not the exam fees.

I believe that is the argument the American Optometric Association is making in reponse to ophthalmology's position.

 

[PBEA]

Dear PBEA,
My opinion of an acceptable scope of practice is really quite reasonable and probably more liberal than a lot of ophthalmologists. For purpose of insight, yes, my father has been practicing for close to 40 years and has really been quite progressive. He owns an large office with 7 lanes and a surgical center housed under the same roof which he rents out to an ophthalmology group. He has manged preoperative and postoperative care for his patients including PKE, PKP, LASIK, RK etc. He owns an OCT, VF, fundus camera and many other gadgets and remains quite up to date. God forbid, his techs even know how to refract. His practice is mostly geriatric and he treats a lot of disease because of this. I'm not entirely sure, but I think he was one of the largest OD prescribers of glaucoma meds in the state. He has sat on the board of his state association and was the president when medication rights were awarded to the OD's in his state. Is he old school? Probably, because he remembers his roots. He also knows when to refer and understands his limitations. This is a sign of a great doc whether MD, DO, DMD, DDS or OD. Perhaps we can get to those fargin reimbursement concerns after all?

The optometric community needs to agree amongst themselves on a scope of practice at a national level. Once this occurs, then perhaps both sides could meet and come to an agreement. Yes, there will need to be compromise on both sides. I'm not sure it will ever be possible, but I would like to think so because I for one think it is rediculous that we spend so much money fighting over this issue.

Another issue has to do with the lobbyists. I think they are partially responsible for perpetuating the whole thing because as long as the fight exists, they have a job. Again just my opnion but someting to think about.

I think your fathers practice is my dreamboat scenario (I'm in private practice with my wife, in a small rural community). What I do is great, and very hands on, Ive got topo, humphrey vf, cameras, pach, but I cant add an OCT or gdx yet and its annoying me (still too many loans). Not to mention an onsite OMD. Maybe one day....Anyway sounds like you might have some realistic "perspective" after all. So lets have it, where do you "draw the line"?

You actually mention the biggest obstacle to uniform scope of practice, its you guys (OMDs), not the state legislatures or even AOA. In my home state of NY, the scope is pathetic, ophthalmology has even tried to take punctal plugs, xalatan, etc AWAY from ODs!? This is absurd, and reflects a pointless, factless stance that your professional assoc continue to take with regard to optometry. It is this purely self serving, political nonsense that interferes with us reaching a "middle" ground. You no doubt will contribute heavily to your PAC, further supporting this crap. I will also contribute to my PAC to prevent this from happening. Those lobbyists who I also feel should be unecessary, unfortunately protect my practice from the likes of your professional assocs who want ODs to "disappear", or limit me to refraction, contact lenses, or "pink" eye. That will never happen.

 

[POJO]

"...The optometric community needs to agree amongst themselves on a scope of practice at a national level. Once this occurs, then perhaps both sides could meet and come to an agreement. Yes, there will need to be compromise on both sides. I'm not sure it will ever be possible, but I would like to think so because I for one think it is rediculous that we spend so much money fighting over this issue...."

I think the morass associated with the many different state laws first sprung up from the opposition by medicine. I think we as optometrist can agree more easily, I think, than medicine can agree to let us define a national standard of scope of practice that makes sense. If medicine will pickup the glove now on massive and undifferentiated opposition, then we can talk.

In law and business, there is the uniform commercial code which a natioanl body created and which individual states tried to adhere to. This UCC is the basis of business transactional and contractual law. Optometry and ophthalmology can create something likes this if both sides are serious. Moderates, though, on each side must be the players, rather than the fringe players.

 

[PBEA]

Ive mentioned this before but Ive got to say it again. I think $600 is a pitifully low amount for ce. How the hell do the dentites get away with making more then that for a friggin crown, Ill never know. Lets face it vision has a long history of misguided perception by doctors and patients, from walmart "exams" to ce reimbursement, this continued infighting has taken the wind from our sails and perpetuates further erosion in the confidence and respect that should permeate quite frankly the exceptionally high skill and training required of eye doctors everywhere.

 

[acurarte]

You no doubt will contribute heavily to your PAC, further supporting this crap. I will also contribute to my PAC to prevent this from happening. Those lobbyists who I also feel should be unecessary, unfortunately protect my practice from the likes of your professional assocs who want ODs to "disappear", or limit me to refraction, contact lenses, or "pink" eye. That will never happen.

With what has happened in Oklahoma I feel obligated and motivated to support the our PAC. It is one thing to have prescribing rights, but legislation in Oklahoma allows OD's to have surgical and laser rights. I certainly draw the line at that point. I have paid my dues and will absolutely fight to keep surgery in surgeons hands. Do you see how the problem is perpetuating? DO you see why their is a need for agreement on a national level?

 

[PBEA]

Do you see how the problem is perpetuating? DO you see why their is a need for agreement on a national level?

Yes, but that is NEVER the message from AAO, or the rest of your political groups. I have never seen ANY concilatory action towards optometry by your representatives EVER. Your powerhouse of medicine has helped your ilk unecessarily restrict optometry from performing that for which it is uniquely trained, all the while claiming that a PCP can handle most eye problems by being a "careful observer", a rather perverse psychology me thinks. Sounds like they are performing chiropractic optometry to me (bring it chiro and i'll slam iridology up your a$$). You fund a campaign that derides optometry at every turn, all the while not realizing that you and I (and your father) are the same, we speak a language no one else speaks (have you ever been to a neurosurgery lecture?) The problem continues to perpetuate.

 

[Olddog1]

That's why a 15 minute cataract pays $600 while 3 comprehensive exams (assume 5 minutes each) pay a grand total of $360.

I can see where ophthalmology is coming from, but the surgery reimbursement should make up the difference, not the exam fees.

In 2007 cataract reimbursement will drop from $683 to $610 (11% cut). PKs will drop from $1199 to $980 (18% cut). The 92002/92012 and 92004/92014 patient visit codes are each taking 12% cuts. Glad I don't do PKs, who would subject themself to that torture, follow-up, glaucoma, rejection, repeat PK for $980 with a 90 day global? Point being it is getting worse for all of us before it will get better.

 

[acurarte]

Yes, but that is NEVER the message from AAO, or the rest of your political groups. I have never seen ANY concilatory action towards optometry by your representatives EVER. Your powerhouse of medicine has helped your ilk unecessarily restrict optometry from performing that for which it is uniquely trained, all the while claiming that a PCP can handle most eye problems by being a "careful observer", a rather perverse psychology me thinks. Sounds like they are performing chiropractic optometry to me (bring it chiro and i'll slam iridology up your a$$). You fund a campaign that derides optometry at every turn, all the while not realizing that you and I (and your father) are the same, we speak a language no one else speaks (have you ever been to a neurosurgery lecture?) The problem continues to perpetuate.

My point is that as long as optometry is seeking surgical rights, I will continue to fight! After speaking to many of my colleagues, they really do not get upset until the topic of surgery and lasers occurs. As long as states like Oklahoma, New Mexico and others continue to strive for surgical rights the AMA & AAO is going to return the fight and restrict other state's OD rights as much as possible. The reason being is that every step toward more rights results in one step closer to surgical rights.

Now, I do not have a problem with OD prescribing rights but it does have to stop somewhere. This is why (since Oklahoma) moderates such as myself have woken up and begun to fight back where as previously we were more quiescent on the whole issue. Many, many more moderates have begun to fund, fight and become more politically active since the OD's have started pursueing surgical rights. We feel like we have been stabbed in the back as perhaps we went against many extremists in the past and have taken heat for saying that OD's should have prescribing rights and now that they do, they are stretching it into surgical rights.

Can you see where we are coming from? It kind of reminds me of how the US provided weapons to muslim extremists to fight the the Russians whom are now using the same weapons to fight the US

(Simply to get my point accross, not saying anyone is like a terrorist so please don't go that route).

 

[POJO]

My point is that as long as optometry is seeking surgical rights, I will continue to fight! After speaking to many of my colleagues, they really do not get upset until the topic of surgery and lasers occurs...

Ok, let's get back to my original question. What is your concept of acceptable privileges or rights for optometry? i hate this bickering about this or that. I agree, surgical rights isn't what I'm interested in. What, then would be agreeable to the general AAO member?

The first thing on my plate is;
1. Lifting the artificial bar on health plan or medical plan provider membership or participation.
2. Accepting optometrists on medical staffs as associate staff members with the ability to consult, order labs and be referred patients from the emerency rooms. Reasonable credentialling requirements.
3. Ability to prescribe any oral or topical medication which is related to an eye condition. For example, one of the silliest was the bar on Restasis. Pure BS by the ophthalmologists. A tit for tat.

I'd like to see your list. The above is what I think the majority of optometrists would be glad and I think could be sold to the majority of optometrists.

 

[acurarte]

Ok, let's get back to my original question. What is your concept of acceptable privileges or rights for optometry? i hate this bickering about this or that. I agree, surgical rights isn't what I'm interested in. What, then would be agreeable to the general AAO member?

The first thing on my plate is;
1. Lifting the artificial bar on health plan or medical plan provider membership or participation.
2. Accepting optometrists on medical staffs as associate staff members with the ability to consult, order labs and be referred patients from the emerency rooms. Reasonable credentialling requirements.
3. Ability to prescribe any oral or topical medication which is related to an eye condition. For example, one of the silliest was the bar on Restasis. Pure BS by the ophthalmologists. A tit for tat.

I'd like to see your list. The above is what I think the majority of optometrists would be glad and I think could be sold to the majority of optometrists.

1. Health, medical plan participation - Ok
2. Hospital privs - perhaps in the ED if this was under the guidance of an ophthalmologist - I feel that medical school and internships has a much greater emphasis on all of medicine that OD's just are not trained in. However, I am hesitant here because I feel as though the OD world will then use this as a springboard to surgical rights. Remember, once bitten twice shy.
3. Prescribing rights for eye conditions - fine, many states are already there and I have no problem with it

 

[Richard_Hom]

2. Hospital privs - perhaps in the ED if this was under the guidance of an ophthalmologist - I feel that medical school and internships has a much greater emphasis on all of medicine that OD's just are not trained in. However, I am hesitant here because I feel as though the OD world will then use this as a springboard to surgical rights. Remember, once bitten twice shy.

Remember that we are trying for a natioanl uniform law. In CA, an agreement was reached between the optometrists and ophthalmologists to agree to scope of practice for 10 years. I think such an agreement can also work nationally.

With such an agreement in hand, I think your objection to hospital privileges of some sort should be moot. I also think that the notion of "associate" privileges usually requires a supervising responsible physician. I think this is workable. In some hospitals, I think it could be a primary care physician (where the hospital doesn't have a full fledged ophthalmologic department) or an ophthalmologists (in larger facilities). I think this benefits everyone because of the communiy-health point of view of optometry that can serve as an entry point for secondary specialized ophthalmologic and primary medical care.

 

[POJO]

1. Health, medical plan participation - Ok
2. Hospital privs - perhaps in the ED if this was under the guidance of an ophthalmologist - I feel that medical school and internships has a much greater emphasis on all of medicine that OD's just are not trained in. However, I am hesitant here because I feel as though the OD world will then use this as a springboard to surgical rights. Remember, once bitten twice shy.
3. Prescribing rights for eye conditions - fine, many states are already there and I have no problem with it

Is #2 concern realistic?

 

[acurarte]

Is #2 concern realistic?

Yes!

 

[acurarte]

Remember that we are trying for a natioanl uniform law. In CA, an agreement was reached between the optometrists and ophthalmologists to agree to scope of practice for 10 years. I think such an agreement can also work nationally.

With such an agreement in hand, I think your objection to hospital privileges of some sort should be moot. I also think that the notion of "associate" privileges usually requires a supervising responsible physician. I think this is workable. In some hospitals, I think it could be a primary care physician (where the hospital doesn't have a full fledged ophthalmologic department) or an ophthalmologists (in larger facilities). I think this benefits everyone because of the communiy-health point of view of optometry that can serve as an entry point for secondary specialized ophthalmologic and primary medical care.

I think that this is the kind of conversation that needs to continue.

 

[VA Hopeful Dr]

In 2007 cataract reimbursement will drop from $683 to $610 (11% cut). PKs will drop from $1199 to $980 (18% cut). The 92002/92012 and 92004/92014 patient visit codes are each taking 12% cuts. Glad I don't do PKs, who would subject themself to that torture, follow-up, glaucoma, rejection, repeat PK for $980 with a 90 day global? Point being it is getting worse for all of us before it will get better.

I had heard that the whole reason surgery reimbursement was being cut was to up the primary care exam fees. Surgeons get screwed but the primary care stuff gets a little boost.

Seems like ODs/MDs get screwed both ways.

 

[PBEA]

I had heard that the whole reason surgery reimbursement was being cut was to up the primary care exam fees. Surgeons get screwed but the primary care stuff gets a little boost.

Seems like ODs/MDs get screwed both ways.

Olddog

Is va hopefuls comment an example of your "budget neutral" remark you made elsewhere? If so, does this concept specialize? In other words, if CE reimbursement goes up, can this money come from other fields of medicine, or does it have to come from opht/opt?

 

[Caffeinated]

Let's be honest, the OMDs dont REALLY(at least not entirely) want what is best for their patients. They really want what is best for their wallets. They employ fear tactics and smear campaigns

I hear that ophthalmologists eat babies by the light of the full moon and they club seals for fun. Let's get serious. Do you see the irony in your statement that ophthalmology uses "fear tactics and smear campaigns" yet you accuse them of not REALLY wanting what is best for patients? If it weren't so offensive, the irony would make me laugh. Has it ever occurred to you that maybe some ophthalmologists want to protect their scope because they think that they are better qualified to provide (fill in disputed treatment/procedure here) and they think that IS what is best for their patients? As a former optometrist turned medical student, I have discovered that most ophthalmologist are regular people too. Contrary to what I used to believe, most of them don't shriek at the sight of a cross or recoil when presented with garlic.

 

[Olddog1]

Olddog

Is va hopefuls comment an example of your "budget neutral" remark you made elsewhere? If so, does this concept specialize? In other words, if CE reimbursement goes up, can this money come from other fields of medicine, or does it have to come from opht/opt?

I have always thought it is one big pot of money and this is divided by everybody (MDs, ODs, chiropractors, NPs, social work, etc...). At some point during the year everybody tries to get a bigger share of the pot for their codes. This year there will be a uniform 5-7% (even more for some specialties) cut for everybody whether you are "procedure" based or not. I don't know if FP reimbursement will go up as suggested by the earlier post. One of the stated goals by Medicare was to get more reimbursement for practioners who spend more "face time" with the patient. However, a friend of mine is in Psych (obviously primarily face time) and he said thier cuts will be bigger than ours this year. In summary, the answer to your question is yes and no; it does not strictly specialize but I am sure year to year they look to see where a large amount of each specialties money goes and try to redistribute within the specialty (that also has to do with the SGR).

 

[POJO]

I hear that ophthalmologists eat babies by the light of the full moon and they club seals for fun. Let's get serious. Do you see the irony in your statement that ophthalmology uses "fear tactics and smear campaigns" yet you accuse them of not REALLY wanting what is best for patients? If it weren't so offensive, the irony would make me laugh. Has it ever occurred to you that maybe some ophthalmologists want to protect their scope because they think that they are better qualified to provide (fill in disputed treatment/procedure here) and they think that IS what is best for their patients? As a former optometrist turned medical student, I have discovered that most ophthalmologist are regular people too. Contrary to what I used to believe, most of them don't shriek at the sight of a cross or recoil when presented with garlic.

I agree, this comment serves only to inflame the situation rather than solving anything. In my opinion, posner's statement was overly simplistic. I think most providers are business and practitioners. Yes, it is probably true that the ophthalmologic profession is fearful of their future because of optometry. But I feel that rather than continually inflaming the situation, it is best to consider a truce.

 

[orangezero]

There are a good deal of optometrists in various places nationwide that have difficulty becoming providers for some or most medical insurances. Does anyone think that this is something ophthalmologists would work toward rectifying (with optometrists) if optometrists agreed to refrain from surgery (not minor surgery defined by medicare, FB removals, etc.)?

 

[luckyfool]

There's some truth to what posner has said. In theory, opto and oMD have the same training for basic eyecare. Now that medicare keeps cutting reimbursement for doctors, all doctors would try to do all that they can to keep the patients. It would be too naive to think that OMD only care for the well being of their patients. For the most part, all healthcare practioners care for the money. It would be hypocritical is say otherwise. Some oMDs I work for dont even send patients back to optometrists, who gave them the referal, for post-op -- normally optometrists do pre- and post-ops. We live in a cynical world..that's all.

 

[DFavell]

Posner said "As a resident I have removed a few pterygiums under the watchful eye of the attending Ophthalmologist, and while It is not particularly difficult, I do not think it necessarily fits into the scope of optometric practice. Stromal punctures I have done and it certainly is not rocket science."

This is scary to me.

There is a saying... you do not know what you do not know.

Understanding risks, benefits and complications of these procedures requires training. What will you do if you penetrate the cornea? Should you be doing a procedure for which you are not trained to handle the complications. Your view of these procedures is too simplistic. Just be cause it looks easy does not mean it can be done easily or that there are not possible vision threatening complications. I am all for ODs doing what they are trained to do.

If you want to perform surgery (and yes stromal puncture is a surgery) go to medical school. Nobody is stopping you.

Expand your scope of practice by expanding your education, not be expanding laws meant to protect patients.

 

[POJO]

Posner said "As a resident I have removed a few pterygiums under the watchful eye of the attending Ophthalmologist, and while It is not particularly difficult, I do not think it necessarily fits into the scope of optometric practice. Stromal punctures I have done and it certainly is not rocket science."

This is scary to me....

DFavell,

I think you your comment has some merit but is misplaced in this post. If you read the post, the author doesn't think that this type of practice is within the author's view of optometry.

If you wanted to express your opinion about the subject, I feel it would be more relevant if you had posted a general reply instead of trying to attack the author.

Obviously, you weren't trying to answer the poster's message but try to get on a soap box again.

 

[DrEyeBall]

Good point. I think DFavell has a point but it did not need to be so inflammatory.

That being said, The statement that these procedures are not rocket science is also inflammatory. I think MDs contribute to this. We see advertising on TV that cataract surgery or LASIK is simple, fast and safe. While it may be in many cases, it is still an interventional procedure and the risks should not be downplayed. Just ask the patient who has had a poor outcome.

 

[POJO]

Good point. I think DFavell has a point but it did not need to be so inflammatory.

That being said, The statement that these procedures are not rocket science is also inflammatory. I think MDs contribute to this. We see advertising on TV that cataract surgery or LASIK is simple, fast and safe. While it may be in many cases, it is still an interventional procedure and the risks should not be downplayed. Just ask the patient who has had a poor outcome.

DrEyeBall,

Granted, but I also believe that posner carefully mentioned that an ophthalmologist was present and overseeing the process. It is quite appropriate for me to think that posner could say what he wanted. ANd DFavell would have a point if ponser was proposing that optometrists could do pterygium removal independently of immediate supervision.

I liken this situation to EMT, FNP etc doing procedures which may not be optimal for the patient but done but done because of a certain set of circumstances are present which would tend to safeguard all parties. I

In sumamry, I don't believe posner is proposing pterygium removal for optometrist.

 

[posner]

Posner said "As a resident I have removed a few pterygiums under the watchful eye of the attending Ophthalmologist, and while It is not particularly difficult, I do not think it necessarily fits into the scope of optometric practice. Stromal punctures I have done and it certainly is not rocket science."

This is scary to me.

There is a saying... you do not know what you do not know.

Understanding risks, benefits and complications of these procedures requires training. What will you do if you penetrate the cornea? Should you be doing a procedure for which you are not trained to handle the complications. Your view of these procedures is too simplistic. Just be cause it looks easy does not mean it can be done easily or that there are not possible vision threatening complications. I am all for ODs doing what they are trained to do.

If you want to perform surgery (and yes stromal puncture is a surgery) go to medical school. Nobody is stopping you.

Expand your scope of practice by expanding your education, not be expanding laws meant to protect patients.[/QUOTE

If I was unclear in my previous post, part of my residency training(very rural setting) was in the use of lasers, some stromal puncture, and some pterygium removal. We had a staff OMD(in fact a few of them that were noted subspecialists in Arizona) that took the time to teach us(much like you were probably taught by your instructors during residency). Again I am not saying ODs should be doing these things; I do not believe that they should.

You should know that there are several OD residency programs where the residents learn and perform stromal punctures. As I said it is not rocket science. Us ODs avoid penetrating the cornea the same way you do- with practice and adequate supervision during the learning process. Much the same way that med students on rotation "learn" to use the DO. We had several of them rotate through, and they new absolutely nothing about the eye beyond its general location in the skull. However, they learned from our instructors and became better clinicians in the process.

And for the record, I did begin Medical school at UC Irvine and completed my first year in the top 20 in my class. It wasnt for me so I moved in another direction. I also wonder if these "laws meant to protect patients" are the same laws that allow non-ophthalmic MDs to perform any eye procedure with impunity. My best friend is a family physician and he removes foreign bodies without a slit lamp, burton lamp, or flourescein with a bent needle. Then he puts his patients on Neomycin eye drops I have recently changed his practices after a discussion.

Lastly, I think that many ODs that want to incorporate more procedures into their patient care regimen, endeavor to expand their education; in almost every case when there is a scope expansion it is usually accompanied by requirements/prerequisites for adequate training and education. Noone is saying we want endless scope expansion without adequate training. This is nothing more than fear tactics by you and your lobby at large.

And one more thing. I cannot tell you how happy I am that we have OMDs in our office. They are all great guys and good clinicians. You know what I love more? The fact that they need me and my practices more than I need them We could send our 40-50 CE/IOL patients per month, multiple LASIK patients, countless retina cases, etc to anyone and they know it. Ther is no ego involved whatsoever. THis is the way that eyecare should work. OMDs should be in the OR utilizing their special skills and spend less time fighting ODs on scope issues that we are more than adequately trained to treat.

Posner

 

[DrEyeBall]

Posner,

You make some good points. I totally agree with you about the fighting between ODs and MDs. It is senseless in most cases. However, there are some in both groups that need to be curtailed. Maybe if the majority of reasonable people in both groups would stand up and be counted, things would be better. The zealots that argue the most probably make up 5% of ODs and MDs but make up 99% of the comments you see and read. I think the ability for ODs and MDs to practice together in the same office provides unique opportunities for both groups.

I also think that some MDs will not "rock the boat" if they see something that is not right if they are being fed cases from a local OD. A friend of mine has told me about all the great feedback he gets from his local glaucoma doctor when he send him cases. On the other hand, that glaucoma doctor has told me how poor some of the management was. WHo is to blame? I think both parties. The glaucoma doc should say something but is afraid the lose the referrals. The OD should be sending the patients sooner but does not want to lose them. In the end, the patients loses.

 

[POJO]

....And one more thing. I cannot tell you how happy I am that we have OMDs in our office. They are all great guys and good clinicians. You know what I love more? The fact that they need me and my practices more than I need them We could send our 40-50 CE/IOL patients per month, multiple LASIK patients, countless retina cases, etc to anyone and they know it. Ther is no ego involved whatsoever. THis is the way that eyecare should work. OMDs should be in the OR utilizing their special skills and spend less time fighting ODs on scope issues that we are more than adequately trained to treat.

Posner

Thank you posner for succintly posting your reply. I'm inclined to agree on most of you what say, especially, the above. As surgeons, ophthalmologists, in my opinion, can best uitlilze their skill in the oR. Refracting and fitting contact lenses, even medically treating glaucoma is something that many would rather not do (in private conversations with ophthalmologists). Those ophthalmologists who support their role as principally surgeons who mainly want to operate support this.

In my opinion, I think that surgeons who feel that the whole of eye care is their sole domain should realize that either their surgical skill is diminishing and they are turning to optometry for their patients or are simply not good enough to stay up with their own peers.

Of course, this cuts both ways. Optometrists who are not trained and/or experienced in advanced management and procedures shouldn't be thinking about them, shouldn't be seeing those kinds of patients etc.

 

[docvisionX]

[delete double post]

 

[docvisionX]

...And one more thing. I cannot tell you how happy I am that we have OMDs in our office. They are all great guys and good clinicians. You know what I love more? The fact that they need me and my practices more than I need them We could send our 40-50 CE/IOL patients per month, multiple LASIK patients, countless retina cases, etc to anyone and they know it. Ther is no ego involved whatsoever. THis is the way that eyecare should work. OMDs should be in the OR utilizing their special skills and spend less time fighting ODs on scope issues that we are more than adequately trained to treat.

Posner

EXACTLY!

 

[bournehall]

What about the general ophth who by performing cataract surgery causes a retinal detachment? He doesn't fix that complication, he refers to retina.

Posner said "As a resident I have removed a few pterygiums under the watchful eye of the attending Ophthalmologist, and while It is not particularly difficult, I do not think it necessarily fits into the scope of optometric practice. Stromal punctures I have done and it certainly is not rocket science."

This is scary to me.

There is a saying... you do not know what you do not know.

Understanding risks, benefits and complications of these procedures requires training. What will you do if you penetrate the cornea? Should you be doing a procedure for which you are not trained to handle the complications. Your view of these procedures is too simplistic. Just be cause it looks easy does not mean it can be done easily or that there are not possible vision threatening complications. I am all for ODs doing what they are trained to do.

If you want to perform surgery (and yes stromal puncture is a surgery) go to medical school. Nobody is stopping you.

Expand your scope of practice by expanding your education, not be expanding laws meant to protect patients.

 

[PDT4CNV]

I just wanted to see if my sentiments are echoed by the masses. I liken optometry in the eyecare business to family medicine in the medical game. WHile I acknowledge I am not and should not perform surgery, I do believe there are many procedures that we should all be performing.

I routinely remove chalazions and papillomas etc, dilate and irrigate puncta, insert and remove plugs, treat glaucoma, perform scleral depression, gonio, treat every red eye I see, work patients up for systemic disease when idicated, order imaging when needed, and I am sure to be involved with the PCP and the medical management of my patients.

As a resident I have removed a few pterygiums under the watchful eye of the attending Ophthalmologist, and while It is not particularly difficult, I do not think it necessarily fits into the scope of optometric practice. Stromal punctures I have done and it certainly is not rocket science. I also think that ODs should be able to perform SLT and YAGs. I dont think LASIK should be performed by ODs. I do not think there should be restrictions on oral meds we prescribe, and I think injectibles would be nice for the removal of superficial lesions and chalazions. Am I missing anything? I really think this would be fair to all involved and would also lead to better patient care in the end. Leave the legitiamte surgeries to the surgeons. I am assuming proof of reasonable proficiency would need to be demonstrated by ODs for some of these procedures. What do the masses think?

Posner

If you are in fact doing what you say you are doing, removing lid lesions, chalazia, operating on pterygia, and corneal micropuncture, you are way outside of the scope of your practice. Please tell me your name and location as I am sure the state medical board would love to hear your explanation for practicing medicine without a medical license. You insurance carrier would probably like know this as well. I worry for you patients as well.

 

[PDT4CNV]

Because we (OD and OMD) do the EXACT same thing. We follow the same protocols, use the same methods of examination, up until surgery ODs and OMDs are basically identical.

That is just not true.

 

[POJO]

If you are in fact doing what you say you are doing, removing lid lesions, chalazia, operating on pterygia, and corneal micropuncture, you are way outside of the scope of your practice. Please tell me your name and location as I am sure the state medical board would love to hear your explanation for practicing medicine without a medical license. You insurance carrier would probably like know this as well. I worry for you patients as well.

Bored in your own forum that you feel like stirring up stuff here ? or too much time on your hands and not enough patients? In other words, your contribution isn't a contribution but another emotional child burst resembling a tearful 6 year old who was said to "no" too many times.

If you do want to post, how about some intelligent discourse. We thirst for your input and knowledge, skill and expertise, but not your sarcasm or emnity.

 

[Ben Chudner]

If you do want to post, how about some intelligent discourse. We thirst for your input and knowledge, skill and expertise, but not your sarcasm or emnity.

But if he gives us his input and knowledge, we will be able to go to our state legislators and tell them that we now have the same knowledge as OMD's so we should be able to perform cataract surgery

 

[posner]

If you are in fact doing what you say you are doing, removing lid lesions, chalazia, operating on pterygia, and corneal micropuncture, you are way outside of the scope of your practice. Please tell me your name and location as I am sure the state medical board would love to hear your explanation for practicing medicine without a medical license. You insurance carrier would probably like know this as well. I worry for you patients as well.

As usual, the OMDs that hijack threads in this forum, choose not to read and digest the entire post. Most of them would rather foment divisiveness then contribute in a constructive manner. I say again, as a resident in a very rural setting I was taught(by OMDs) some of the aforementioned procedures and I did perform one or more of them on several occasions. In private practice, I do not perform these procedures as they are currently outside my scope of practice. Also, I do not believe the scope of practice for optometry should include pterygium removal(again I have said this several times previously). I do think there should be some allowance for superficial/mildly/non invasive lid lesion excision/biopsy and a few other things, however.

Furthermore, you need not worry for my patients. I however, worry for my patients in that there seems to be a growing number of general ophthalmologists that because of shrinking reimbursements think they should be doing botox, some oculoplastics, trabs, lower blephs, some retina etc in addition to fighting with ODs for red eyes and glaucoma. Many of these OMDs are dreadfully poor surgeons beyond cataract surgery. My neighbor is a local plactic surgeon and she says her best patients are those that have had botched blephs(lowers and uppers) with local OMDs. It goes on and on.

The message again folks, is that you need to be sure you have some value to your local OMDs(sadly this value will only come when they perceive that you will send them a significant volume of patients for them to operate on). Until you do this you get no respect, plain and simple. It is truly amazing what happens to OMDs(especially their egos) and your relationship with them when they come to depend on your referral business for much of their income. I routinely play golf and poker with 2 local OMDs and they are really nice guys.
If you are a small time practice or in a large metro area, forget about ever forging a good relationship with OMDs. They dont need you in this type of situation, so they will look down on you.

Posner

 

[VA Hopeful Dr]

That is just not true.

What do MDs do differently in an eye exam that ODs don't?

 

[PBEA]

That is just not true.

I think you need a good dose of reality. Are you still in training?

 

[POJO]

But if he gives us his input and knowledge, we will be able to go to our state legislators and tell them that we now have the same knowledge as OMD's so we should be able to perform cataract surgery

Oops! You mean they'll be like super optomerists?

 

[PBEA]

As usual, the OMDs that hijack threads in this forum, choose not to read and digest the entire post. Most of them would rather foment divisiveness then contribute in a constructive manner. I say again, as a resident in a very rural setting I was taught(by OMDs) some of the aforementioned procedures and I did perform one or more of them on several occasions. In private practice, I do not perform these procedures as they are currently outside my scope of practice. Also, I do not believe the scope of practice for optometry should include pterygium removal(again I have said this several times previously). I do think there should be some allowance for superficial/mildly/non invasive lid lesion excision/biopsy and a few other things, however.

Furthermore, you need not worry for my patients. I however, worry for my patients in that there seems to be a growing number of general ophthalmologists that because of shrinking reimbursements think they should be doing botox, some oculoplastics, trabs, lower blephs, some retina etc in addition to fighting with ODs for red eyes and glaucoma. Many of these OMDs are dreadfully poor surgeons beyond cataract surgery. My neighbor is a local plactic surgeon and she says her best patients are those that have had botched blephs(lowers and uppers) with local OMDs. It goes on and on.

The message again folks, is that you need to be sure you have some value to your local OMDs(sadly this value will only come when they perceive that you will send them a significant volume of patients for them to operate on). Until you do this you get no respect, plain and simple. It is truly amazing what happens to OMDs(especially their egos) and your relationship with them when they come to depend on your referral business for much of their income. I routinely play golf and poker with 2 local OMDs and they are really nice guys.
If you are a small time practice or in a large metro area, forget about ever forging a good relationship with OMDs. They dont need you in this type of situation, so they will look down on you.

Posner

Keep up the good work Posner! I just want to contribute by saying that I have also seen both types of OMDs. Though, I dont agree with all of your "characterizations" regarding ophthalmology, the simple fact is that you can get bad kinds of any doctors (as you clearly inferred). My daily anecdote includes a new pt with heavy duty nipple kcone (88ks and around 300 microns) BCVA OS 20/200, PKP OD BCVA 20/200 (no cl), recently lost RGP OS. Basically on the verge of PKP OS (topo is off the hook). Desperate about his VA, even though I just started with a diagnostic lens (plano). Pt calls "old" OD (who hasnt examined pt in almost two years) places order for cl over the phone and voila! a new cl in the mail! WTF is that about?! So the door swings both ways thats for sure.

Im in a small town practice and have "decent" relationships with retina, cataract, etc. I admit to not being as diligent in following up with referred "out" patients (as far as know I see "most" of them back) , although I do a pretty good job with referred "in" patients. Ive heard this before and it represents great insight, so thank you for reminding me to get off my ass.

 

[Ben Chudner]

I say again, as a resident in a very rural setting I was taught(by OMDs) some of the aforementioned procedures and I did perform one or more of them on several occasions. In private practice, I do not perform these procedures as they are currently outside my scope of practice. Also, I do not believe the scope of practice for optometry should include pterygium removal(again I have said this several times previously).

Before jumping down PDT4CNV's throat, you should look at the quote he was referring to:

I routinely remove chalazions and papillomas etc, dilate and irrigate puncta, insert and remove plugs, treat glaucoma, perform scleral depression, gonio, treat every red eye I see, work patients up for systemic disease when idicated, order imaging when needed, and I am sure to be involved with the PCP and the medical management of my patients.

Considering chalazion removal is in fact outside the scope of Optometry in the majority of the country, including California (I am not sure how many or which states allow papilloma removal), I can understand why he got all bent out of shape. I do believe there are more constructive ways of questioning people on this forum, however, but maybe that is a discussion for another time. And he did lump other procedures such as pterygium removal into his rant which you clearly explained was performed in your residency under direct supervision of an OMD. I generally agree with the ideas you present on this forum Posner, but when you make claims such as the ones above, you should expect to be called onto the carpet.

 

[posner]

Before jumping down PDT4CNV's throat, you should look at the quote he was referring to:Considering chalazion removal is in fact outside the scope of Optometry in the majority of the country, including California (I am not sure how many or which states allow papilloma removal), I can understand why he got all bent out of shape. I do believe there are more constructive ways of questioning people on this forum, however, but maybe that is a discussion for another time. And he did lump other procedures such as pterygium removal into his rant which you clearly explained was performed in your residency under direct supervision of an OMD. I generally agree with the ideas you present on this forum Posner, but when you make claims such as the ones above, you should expect to be called onto the carpet.

Point taken Ben. Perhaps I should proof my posts more. For Clarification, I have not performed a chalazion removal or pterygium removal since my residency. I do however, routinely scleral depress, probe/dilate/irrigate, etc. I appreciate you taking me to task(or defending those who have appropriately done so); it is my ultimate intention to foster constructive discussions on ways to provide better patient care. Sadly, objectivity is often thrown out the window when the discussion becomes heated.

Posner

Posner