HR 5688 - “Healthcare Truth and Transparency Act"

From these documents, it seems that there are surveys done that show the general public mistaking optometrists for MDs. But within the bill it says that non MD practioners are misleading the public. Is there any evidence for this? The public's faulty perception is different from an optometrist actively faking his credentials. In all the optometrist offices i have been to, their degree diploma is for all to see and there is never any reference to the fact that they are "mds." Even the office usually says "optometry" or "optometric services." Of course the public should now about the differences, but this bill seems to suggest that OD's are actively trying to hide the differences.

This bill is fine in that it wants to inform the public, but i hope that the will show the evidence they have regarding optometrist pretending to be MDs. Those pretenders should be punished but I am sure they are in the very low minority.

There is also a line that irks me, "while there is a role for non MD practioners...qualification of the providers treating them." Are they saying that optometrist are not as qualified to fit contact lens as medical doctors? Or are optometrist training inadequate for thier job function? Seems like its another case of "see a REAL doctor" if you want the best care.

jefguth said:

I'm sure the vast majority of you have now all heard of this bill introduced by Rep. Sullivan (R-OK) that purports to eliminate deceptive representation in the provision of health care, but I thought it might be worth discussing.

Basically this bill would prohibit non-MD/DO, DDS/DMD health care professionals from holding themselves out as such (which is fine) and from describing ones "profession, skills, training, experience, education, or licensure in a fashion that causes the public ... to believe that such person is" an MD/DO or DDS/DMD - which could be a problem for optometry.

Also, the bill includes language which I would take exception to by implying that OD's (amont others) chronically misrepresent themselves as medical doctors (and dentists?). This stikes me as slanderous.

While upon a quick look at the bills text it probably looks innocuous , I am concerned about the very vague manner in which it is written - ambiguities that are cause for alarm. Would this bill push the FTC to investigate OD's that make use of the titles, such as "doctor," granted to them by privilege of state licensure b/c the AMA says patients might think an optometrist is an MD?

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I don't understand the dentist part. This is a very stupid bill. The Republicans will lose control of Congress in the mid-term elections.

blazenmadison said:

I don't understand the dentist par.

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the dentist part is probably thrown in there to garner the support of the dentists. dentist dont really tread on the turf for MDs (except oral surgeons) so why not enlist thier help in this bill?

still_confused said:

From these documents, it seems that there are surveys done that show the general public mistaking optometrists for MDs. But within the bill it says that non MD practioners are misleading the public. Is there any evidence for this? The public's faulty perception is different from an optometrist actively faking his credentials. In all the optometrist offices i have been to, their degree diploma is for all to see and there is never any reference to the fact that they are "mds." Even the office usually says "optometry" or "optometric services." Of course the public should now about the differences, but this bill seems to suggest that OD's are actively trying to hide the differences.

This bill is fine in that it wants to inform the public, but i hope that the will show the evidence they have regarding optometrist pretending to be MDs. Those pretenders should be punished but I am sure they are in the very low minority.

There is also a line that irks me, "while there is a role for non MD practioners...qualification of the providers treating them." Are they saying that optometrist are not as qualified to fit contact lens as medical doctors? Or are optometrist training inadequate for thier job function? Seems like its another case of "see a REAL doctor" if you want the best care.

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This bill comes from a two main directions.

1) Many nursing schools are beginning to offer DNP degrees. This would techinically allow nurse practitioners to call themselves Doctor.

2) MD/DOs are somewhat leary of the term physician being used by every Tom, Dick, and Harry with a professional doctorate (chiropractic physician, naturopathic physician, optometric physician, and so on). They worry that patients will be confused by such things.

To be honest, this law has very few real applications that would harm non-physician providers. Though there is one part that has me a bit concerned.

"consumers believe that complex medical issues, surgeries, procedures, and prescribing medications should be performed by medical doctors."

Other than that one part, all the bill does is draw a big line between physicians, and dentists, and everyone else.

All that being said, I don't really see the need for it. I think this would be better handled at the state level or within each individual hospital. But that's just me.

VA Hopeful Dr said:

This bill comes from a two main directions.

1) Many nursing schools are beginning to offer DNP degrees. This would techinically allow nurse practitioners to call themselves Doctor.

2) MD/DOs are somewhat leary of the term physician being used by every Tom, Dick, and Harry with a professional doctorate (chiropractic physician, naturopathic physician, optometric physician, and so on). They worry that patients will be confused by such things.

To be honest, this law has very few real applications that would harm non-physician providers. Though there is one part that has me a bit concerned.

"consumers believe that complex medical issues, surgeries, procedures, and prescribing medications should be performed by medical doctors."

Other than that one part, all the bill does is draw a big line between physicians, and dentists, and everyone else.

All that being said, I don't really see the need for it. I think this would be better handled at the state level or within each individual hospital. But that's just me.

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I'm afraid to say this bill has nothing to do with your two reasons. There is a trend lately to go on the offensive so your opponent has no choice but to play defense. Ophthalmology knows that if we have to spend our time and money fighting these bills, we can't focus on more important issues like a uniform scope of practice. This is same tactic we saw in Florida and Washington with the co-management bill (FL) and the refracting opticians bill (WA). This is simply an attack on optometry for the sake of keeping us busy and cleverly written so that other health professions, like dentistry, will support it. You'll notice they keep bringing up their biased survey with no real evidence of damage caused to any patient, nor any formal complaints that a patient was misled into thinking they were seeing an MD rather than an OD.

Here's a "no-brainer" cure for this: Simply change:

"medical doctor, doctor of osteopathic medicine, doctor of dental surgery, and doctor of dental medicine"

To:

"medical doctor, doctor of osteopathic medicine, doctor of dental surgery, doctor of dental medicine, and doctor of optometry"

Then its a bill we all can support!!!

Otherwise, my reading of this bill would make it illegal (or deceptive/unfair trade practice) for any optometrist to describe themselves as an "eye doctor". Heaven forbid you should have the term "eye doctor" in the name of your practice, etc...


Just my $0.02. I'm often curious why a DDS/DMD (or a DO that matter) is held in the same esteem as an MD but an OD is not. Are dentists required to take more training, or do residencies that ODs aren't???

"DO's" have the same "unlimited" license that MD's have. DO has an education similar to MDs and attend residencies to determine thier speciality, in many cases DO's attend MD residency. This is why DO's are grouped together with the MDs. I really dont care whether we are grouped together with MDs, nurses, or any other group. All i really care about is that OD's can practice to the full extent of thier license defined by state law without any other group attacking what we do, questioning our qualifications, or our competancy.

This bill may or may not have good intentions, but i think informiing the public is imperative. Hopefully a bill can be written that wont blantantly attack optometrist or any other group while protecting the priviledges that MDs, DOs, NP, dentist and any other group have earned.

I can see why the title Doctor can be confusing to some patients and equating it with a medical degree, but the Mds do not have a monopoly on the "doctor" title. This is where public education is important.

again, I would like the optometric community to have access to data that shows optometrist misleading thier patients and optometrist perscribing harmful medication or medication that they were not licenses to perscribe. By seeing this data, only then can the optometry community fix its internal problems and reform to be less "offensive" towards MDs.

This bill doesnt have a snow ball's chance in hades.

These bills come down the pike every now and again and are always promptly defeated by a grassroots outcry from the DCs, ODs, DPMs, DVMs, and now increasingly the DPTs, and NDs.

The MDs and DOs can't plead with their patients to write congressmen like these other professions can and after a few thousand letters even congressmen can take a hint.

Here is the question. If a guy had a acute MI on the side of the road and someone turned to you and asked you "are you a doctor??". What would you say? I argue that in that situation, only a physician (MD/DO) would be able to say "yes". Any other "doctor" professional that says 'yes' would be misrepresenting him/herself. It is obvious from the context that doctor implies medical doctor.

That question there sums up the difference between Doctor and Doctor (yes, same word, but you know what I mean). You called your professors in college Dr. but would they ever identify themselves as Doctor during a medical emergency? I dont think any OD, NP, DPT, DNP would identify themselves as a doctor in the situation described above.

Doctor does denote a certain level of education, and hence, OD's are just as much a doctor as a DDS and a MD. Unfortunately, the term Medical Doctor and Doctor are also used interchangeably and thus is the source of the public's confusion.

exmike said:

Here is the question. If a guy had a acute MI on the side of the road and someone turned to you and asked you "are you a doctor??". What would you say? I argue that in that situation, only a physician (MD/DO) would be able to say "yes". Any other "doctor" professional that says 'yes' would be misrepresenting him/herself. It is obvious from the context that doctor implies medical doctor.

That question there sums up the difference between Doctor and Doctor (yes, same word, but you know what I mean). You called your professors in college Dr. but would they ever identify themselves as Doctor during a medical emergency? I dont think any OD, NP, DPT, DNP would identify themselves as a doctor in the situation described above.

Doctor does denote a certain level of education, and hence, OD's are just as much a doctor as a DDS and a MD. Unfortunately, the term Medical Doctor and Doctor are also used interchangeably and thus is the source of the public's confusion.

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I like the example you used of the heart attack on the side of the road. I don't think any OD would say "Yes, I'm a doctor." But, perhaps they would step forward with a little more medical knowledge than the average Joe and be able to help out a little, I don't know.

I suppose what frustrates me, as a future optometrist, is that because of the sheer ignorance of the public, I should have to go around "qualifying" my education. "Why yes, Mrs. Jones, I am a doctor, but you know, not a REAL doctor, because I ONLY had 8 years of post secondary education as opposed to the 12+ that a REAL doctor had." What should I be punished and not be able to call myself a doctor, which I will be... of optometry... when the public is the one's who need more education, not me!

I just want to be an optometrist... or... a DOCTOR of optometry. That's it. I know that I'll have to spend hours of my life illustrating why I'm different from a REAL doctor, but... such is life. I don't want to be a medical doctor, or I'd be one. I'm not going to try and set up a health clinic and bilk (sp?) the unsuspecting and uneducated public out of money. I just want to be an optometrist, and take care of my patients to the fullest extent of my training, and be able to bill for it. Nothing more and nothing less. Try as the authors of this bill might, they shouldn't be able to take away the title that a lot of time and money and hard work has earned me.

prettygreeneyes said:

I just want to be an optometrist... or... a DOCTOR of optometry. That's it. I know that I'll have to spend hours of my life illustrating why I'm different from a REAL doctor, but... such is life. I don't want to be a medical doctor, or I'd be one. I'm not going to try and set up a health clinic and bilk (sp?) the unsuspecting and uneducated public out of money. I just want to be an optometrist, and take care of my patients to the fullest extent of my training, and be able to bill for it. Nothing more and nothing less. Try as the authors of this bill might, they shouldn't be able to take away the title that a lot of time and money and hard work has earned me.

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Yup.

jefguth said:

I have to wonder how the DDS would respond to the situation. Like OD's they most likely would not have had the experience of handling a MI like that, but like other providers they are required to be certified in CPR and have an ethical obligation to provide assistance. I'm sure it would be ideal to have a physician onsite that has experience managing MI, but given you are talking about the side of the road its hardly ideal circumstances. Which makes me wonder, if in such a situation the DDS is no more a "doctor" (as in medical doctor) than an OD, why is it that medicine and dentistry have aligned themselves behind this bill? My guess is political manouvering.

Certainly your scenario is an interesting one that makes us wonder how we would respond, but how relevant is it really to the day to day patient-provider relationships in health care and the use of a title. For sure noone is concerned about how they are addressed or how they address themselves when there is the more importan matter of a person suffering a MI next to the road. Upon further thought, I might have to agree that saying "yes" approaches a misrepresentation - so I would say "no," but quickly add that I'm am certified in CPR and obligated to assist.

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Great points, particularly regarding the DDS question! In the MI situation, surely a physician is best... but, is a DDS better than an OD, or DC, or NP? If not, then why do the dentists of the world get a pass on "representing themselves as doctors" while the rest of the "doctorate" health professions get the proverbial "shaft"?

jefguth said:

This is an interesting scenario. Honestly, I'm not sure how I would respond to the question, I guess saying "no" would require less explanation. While obviously as an optometrist I would not be a physician, which is what this person is looking for, but in the scenario just about any licensed health care provider should be able to render some level of assistance via CPR. Now this is not a loaded question; but would an MD who happens to be on the scene without any specialized insturments or medications really be in the position to do much more for this person. Obviously I would expect the MD to have more experience with such a situtation, but given the circumstances I would imagine not much can be done until this person makes it to the ER. Just curious, please excuse any ignorance I may have just revealed.



I have to wonder how the DDS would respond to the situation. Like OD's they most likely would not have had the experience of handling a MI like that, but like other providers they are required to be certified in CPR and have an ethical obligation to provide assistance. I'm sure it would be ideal to have a physician onsite that has experience managing MI, but given you are talking about the side of the road its hardly ideal circumstances. Which makes me wonder, if in such a situation the DDS is no more a "doctor" (as in medical doctor) than an OD, why is it that medicine and dentistry have aligned themselves behind this bill? My guess is political manouvering.

Certainly your scenario is an interesting one that makes us wonder how we would respond, but how relevant is it really to the day to day patient-provider relationships in health care and the use of a title. For sure noone is concerned about how they are addressed or how they address themselves when there is the more importan matter of a person suffering a MI next to the road. Upon further thought, I might have to agree that saying "yes" approaches a misrepresentation - so I would say "no," but quickly add that I'm am certified in CPR and obligated to assist.

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You're last sentence is the crux of my little scenario. You're detracting from my point by arguing who if anyone is qualified to perform CPR, since my grandma could learn to be CPR certified. My point was simply to illustrate that many people think doctor=medical doctor.
In that sense, it is misleading for any non health professional to say "I'm a doctor" unless you have a MD or DO.

Lets put it another way. If a family friend asked your mother what you did as a profession, your mother (or anyone you know) would reply "He is a Dentist/Optometrist/Podiatrist/etc. Only a medical doctor would be referred to as a doctor. Or even simpler. If someone asked you what you did for a living, would you say "I'm a doctor"? No, you'd say I'm a optometrist/dentist/blahblah. Only a physician could say "I'm a doctor" without being misleading.


On the other hand, there is absolutely nothing wrong with saying you're Dr. Blank to your patients or anyone you meet. You successfully completed four years of post college doctorate level work. You earned it.

I don't think anyone is arguing that OD/DDS/DPT/etc dont deserve the title of doctor. You went through the schooling, you deserve to be addressed in a way commesurate with your level of education. As it is with any profession, there are always bad apples that are willing to mislead and embarass their own profession. Unfortunately, groups are often judged by the exception to the rule rather than the norm.

no sane optometrist or any other person is going to be running around proclaiming themselves to be a "doctor" especially if there is someone with a heart attack.

the public's perception of a doctor is a MD, but that is not the fault of the the optometrist. this bill seems to want to punish optometrist for calling themselves by the degree they earned. Again, i would like to see evidence regarding optometrists pretending to be MDs and see them punished accordingly.

many of the MDs i have met do not address themselves as doctors but rather dermatolgist, opthamologist, gastrologist, etc. By being specific, it will limit misunderstandings. I support the bills call for public education and the limiting of fraud, but the spirit is immature, just as immature as the AOA !

exmike said:

In that sense, it is misleading for any non health professional to say "I'm a doctor" unless you have a MD or DO.

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I would really like to know exactly WHO is walking around calling themselves a "doctor" in your sense of the word? Is this a nationwide epidemic, and us SDNers are the last to know about it?

On another note... exmike I appreciate you participating in civil discourse with us on this matter. If I understand correctly, you are an practicing ophthalmologist or resident?

jefguth said:

If you feel strongly about this issue but haven't yet found time to write to your represenative in Congress, then consider sending this quick message already prepared for you by the AOA! http://capwiz.com/theaoa/issues/alert/?alertid=8881916

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Thanks for the link jefguth! My letter is already sent, and hopefully my Congressman will listen, as he is running for Governor in Nevada!

All OD's and students should read the OMD thread regarding this bill. In it you will see a classic example of their tactics. Misquote what we say and use it to fire themselves up.

Ben Chudner said:

All OD's and students should read the OMD thread regarding this bill. In it you will see a classic example of their tactics. Misquote what we say and use it to fire themselves up.

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here we go again.

thank you so much for letting us know.


The bill is currently in the Subcommittee on Commerce, Trade, and Consumer Protection. the following are the members on the subcommittee. try to contact them and maybe we can get the bill killed in subcomittee.
the chairman is Cliff Stearns, a supporter of OMDs

status of the bill:
http://thomas.loc.gov/cgi-bin/bdquery/z?d109:HR05688:@@@P
(Althought one of the original cosponsors dropped out, additional reps have joined)
contacts for the subcommittee:
http://energycommerce.house.gov/108/subcommittees/Commerce_Trade_and_Consumer_Protection_Members.htm

Ben Chudner said:

All OD's and students should read the OMD thread regarding this bill. In it you will see a classic example of their tactics. Misquote what we say and use it to fire themselves up.

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Yes, I read that one gentleman's post and I was a bit disturbed to say the least. It seems to me that this bill is fueled by an array of insecure "medical doctors". I personally still can not understand why the republican party is going out of its way to make this bill a priority because it really isn't a "misrepresentation" when your degree says Doctor of Optometry or Doctor of Physical therapy, Doctor of Chiropractor, or even Doctor of Podiatric Medicine. At the end of the day, we are all professionals who will solely stick to our respective scopes of practice. Every professional has his degree clearly displayed at the office and if there are INDIVIDUAL cases where misprepresentation does actually occur then these INDIVIDUALS should be punished by the laws and their respective associations instead of punishing the entire association as a whole.

I strongly agree with one of the earlier posts regarding the purpose of this bill as to slow down or distract the progress of the respective professionals involved. I understand that the optometrists are fighting for uniform scope of practice just like how us podiatrists are also attempting to set a uniform scope of practice for foot and ankle surgeries. An ignorant bill like the one presented is not only a big liability on our professions but is a straight slap in the face for all the hard work and years of dedication that we've invested.

Podman said:

I strongly agree with one of the earlier posts regarding the purpose of this bill as to slow down or distract the progress of the respective professionals involved. I understand that the optometrists are fighting for uniform scope of practice just like how us podiatrists are also attempting to set a uniform scope of practice for foot and ankle surgeries. An ignorant bill like the one presented is not only a big liability on our professions but is a straight slap in the face for all the hard work and years of dedication that we've invested.

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Thanks for joining the discussion, Podman. Do podiatrists have a national association to help fight the passage of this bill? Us "fake doctors" have to work together!

prettygreeneyes said:

Thanks for joining the discussion, Podman. Do podiatrists have a national association to help fight the passage of this bill? Us "fake doctors" have to work together!

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i believe the issue has been presented to the APMA (american podiatric medicine association), but it is still upto every single one of us to contact our representatives in order to put a stop to this none-sense.

still_confused said:

Of course the public should now about the differences, but this bill seems to suggest that OD's are actively trying to hide the differences.

There is also a line that irks me, "while there is a role for non MD practioners...qualification of the providers treating them." Are they saying that optometrist are not as qualified to fit contact lens as medical doctors? Or are optometrist training inadequate for thier job function? Seems like its another case of "see a REAL doctor" if you want the best care.

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TRYING to actively hide the difference. How about trying to get the same/similar rights as an ophthalmologist because there isn't enough of them in OK? That is quite slanderous, and a big slap in the face of people who actually were accepted to medical school. 8+ years vs. 4. Give me a break.

See a real doctor if you want the best care. I'm sure that I want to go to LensCrafter for my uveitis. Sure it feels degrading, but you don't see me assuming new roles. Earn the right to call yourself a "pseudo-ophthalmologist. Go through med school and get good scores on your exams rather than circumvent through OD school. What kind of response do you expect? People work hard through medical school and feel that someone who can't get at least 28 on their MCAT, etc. shouldn't be doing the same thing in the end.

m3unsure said:

TRYING to actively hide the difference. How about trying to get the same/similar rights as an ophthalmologist because there isn't enough of them in OK? That is quite slanderous, and a big slap in the face of people who actually were accepted to medical school. 8+ years vs. 4. Give me a break.

See a real doctor if you want the best care. I'm sure that I want to go to LensCrafter for my uveitis. Sure it feels degrading, but you don't see me assuming new roles. Earn the right to call yourself a "pseudo-ophthalmologist. Go through med school and get good scores on your exams rather than circumvent through OD school. What kind of response do you expect? People work hard through medical school and feel that someone who can't get at least 28 on their MCAT, etc. shouldn't be doing the same thing in the end.

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The best doctors are the ones that work together! Most Optometrists (ODs) want to be Optometrists and most Eye MDs/Surgeons (Opthalmologists) want to fulfill their role in the system too. Take a look at a few practices. In a competetive environment working together benefits both professions. i.e., synergy is always better than contention!

a few examples
http://www.gotovisionamerica.com/OurDoctors.aspx
http://www.denvereyesurgeons.com/doctors.html
http://www.eyespecialistsofohio.com/DOCTORS.htm

p.s. - most ODs go to OD school cause they want to be ODs not because they want to be Opthalmologists and/or couldn't get into an MD school. Sure if at MD school, likely 96% of pre-OD students couldn't match into Optho residency but neither could 89% of pre-MD students or 94% of pre-DO students either. Focus on the issues that matter and leave the bashing others to the apes. MDs aren't the only smart people alive. There are smart people in all walks of life. As far as Career choices go, people choose what they choose for many many reasons.

m3unsure said:

People work hard through medical school and feel that someone who can't get at least 28 on their MCAT, etc. shouldn't be doing the same thing in the end.

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The MD/God Complex rears its ugly head...

where are OD's trying to actively hide the difference? Where is an OD running around pretending to hold a MD degree?

your example with the oklahoma ODs is a good point, i will respect you on that. Do you want me to fight with you against OD's doing surgery (as defined by the law for those that want to scream about the difference between minor and major surgeries) I will gladly do it. I will say that I totally agree with you on this point but this is not what the bill is about.

what defines "real doctors?" Medical school? Doctors are those that recieve a doctorate degree. Is the public confused? yes. does that make you a realer doctor then anyone else with a doctorate degree? no. Do i really care about my title? No. I just want to do what i went to school for and what i will be licensed to do, that is all. Thats the problem i have with this bill and not the pointless argument over a title which you seem to guard closely.

and where in the world are people getting into medical school with a 28??? Is that a suppose to be a joke? Noone i know is going anywhere without at least a 32.

ps. blazen, are you poking fun at DOs and people that go to the carribean? that is uncalled for. They work just as hard as everyone else. We dont need to be making fun of other people's professions (thats what the OMDs are for!). Try not to sink to thier level.

blazenmadison said:

You make it sound like ODs are medical school rejects. You're so funny. Go talk to your DO and carribean friends. ODs want to be optometrists, not eye surgeons.

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Or the bazillion geniuses that studied at the University of India. I'd trust an optometrist any day from an American school over some of them.

We as optometrists or future optometrists don't like people assuming that we are medical school rejects because we went to optometry school. Treat the DOs and FMGs with the same respect.

EDIT: I put FMD, but I think it is FMG... Sorry!

prettygreeneyes said:

We as optometrists or future optometrists don't like people assuming that we are medical school rejects because we went to optometry school. Treat the DOs and FMDs with the same respect.

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I didn't mean it to sound like that. I do apologize to those I offended. Heat of the moment. I do respect everyone, except a minority of OMDs.

Podiatrists have written presciptions for as long as there have been podiatrists. What's the deal here-some Oklahoma congressman gets a few lobbyist dollars-so what.

jefguth said:

The sad thing about all the political wrangley that goes one between professions is that neither the patients nor the practioners really get anything out of it. The patients get some useless bill like this one which doesn't really have real world consequens because the only agency that can inforce its vague definitions, that are contary to what state legislation allows, is the Federal Trade Commission (oh no not the FTC :O ), and the professionals waste all their association dues courting congressmen and women to fight each other in the capital. Score one for the election campaign coffers.

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Keep it civil, folks. Spirited discussion is fine, but interprofessional arguments can get ugly quickly if people don't play nice.

blazenmadison said:

I didn't mean it to sound like that. I do apologize to those I offended. Heat of the moment. I do respect everyone, except a minority of OMDs.

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I have an MD degree and a DPM degree. I have been out in practice for a long time.

I worked in a med center where DOs rotated through along with MD students and DPM students.

Most of the DOs were sons or daughters of $ people-I recall being a young bozo interviewing for a DPM residency and the DO asked if I wanted to be a DO and said that 40K would ensure me a slot...then the hospitals DO do your homework how many have had problems with the government? Why do you potential students believe that being a DO is anywhere near being an MD.

These folks were less than adequately prepared for any doctoral education than my old topsiders. They knew they couldn't cut the MD degree in the states and opted to DO OUT. Can you still pay your way into DO school?

If you know you won't say.

But you know what I mean - there are not many natural born healers who choose to scribble DO after their name without some bizarre knowledge that -yeah you can make a lotta loot."

IMGs from the US have the guts to take the chance and loose if they may know they took a chance.

Where is the Harvard or Yale college of Osteopathic. Think about it.

Podiatrists at least know they are at the low end of the feeding tube-but provide a REAL medical service-confused as they are.

DO. Come on, if you had the choice grammy and little Ned would not know the diff if you were Doc Holliday or Ricky Bobby.

I am done with being any kinda doc-you can call me A-hole or whatever.
If you want advice-talk to the elders of the tribe.

Cap Sulotomy said:

I have an MD degree and a DPM degree. I have been out in practice for a long time.

I worked in a med center where DOs rotated through along with MD students and DPM students.

Most of the DOs were sons or daughters of $ people-I recall being a young bozo interviewing for a DPM residency and the DO asked if I wanted to be a DO and said that 40K would ensure me a slot...then the hospitals DO do your homework how many have had problems with the government? Why do you potential students believe that being a DO is anywhere near being an MD.

These folks were less than adequately prepared for any doctoral education than my old topsiders. They knew they couldn't cut the MD degree in the states and opted to DO OUT. Can you still pay your way into DO school?

If you know you won't say.

But you know what I mean - there are not many natural born healers who choose to scribble DO after their name without some bizarre knowledge that -yeah you can make a lotta loot."

IMGs from the US have the guts to take the chance and loose if they may know they took a chance.

Where is the Harvard or Yale college of Osteopathic. Think about it.

Podiatrists at least know they are at the low end of the feeding tube-but provide a REAL medical service-confused as they are.

DO. Come on, if you had the choice grammy and little Ned would not know the diff if you were Doc Holliday or Ricky Bobby.

I am done with being any kinda doc-you can call me A-hole or whatever.
If you want advice-talk to the elders of the tribe.

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Ummm... If you want to delve into the superiority of an MD over a DO, try one of the medicine forums, where I'm sure there are MANY people who would love to debate you. A point was raised about the education of a DO, but only with regards to HR 5688 and how it will affect optometry. We have enough things to worry about... MD/DO turf wars aside.

That Bill will never pass. There are too many PACs and lobby groups out there (e.g., pharmacy, clinical psych, optometry, audiology, chiro, etc.) that would be harmed by the passage of this Bill.

It's funny to see the ODs so up-in-arms over this petty issue. Nothing is going to change for you guys, so relax. More and more health professionals are earning professional doctorate degrees, so this issue is becoming more prevalent out there. Today, it's possible that your pharmacist, physical therapist, and NP all have doctorates; it's possible that your optometrist and clinical psychologist can write Rx's for various meds, and it's possible that your PT may have direct access to patients. Health care is changing. Physicians often become somewhat apprehensive about all the changes, even the more liberal physicians right out of school.

One thing optometrists and pharmacists and chiropractors and others can do is be precise and specific with words when referring to yourself in front of patients or others. Eye doctor may be appropriate in your mind, but you really should refer to yourself as an optometrist and also have your staff call you an optometrist. Using the title "doctor" is fine as long as you qualify it somehow. You shouldn't be wearing long white coats with embroidered name tags proclaiming yourself as Dr. X. If you need a white coat, use Bob Jones, O.D., Optometrist. If your patients are uneducated and have no clue what that is, then "eye doctor" would be okay in that instance.

NEVER, EVER, EVER, refer to yourself as an optometric PHYSICIAN. I don't care if it's legal in your state, DON'T DO IT. Why would you even want to subject yourself to potential liability? Do you realize that many chiros and others who call themselves PHYSICIAN (chiropractic physician, dental physician, optometric physician, naturopathic physician) CAN be held to the same standard of care, in a civil malpractice suit, as an MD or DO if that title is used and induces a patient to act or fail to act in a certain way? Plus, no matter what some states allow, you are NOT physicians. THAT IS MISLEADING and DECEPTIVE. An MD, DO, OMFS, and a podiatrist, is a physician; an optometrist, psychologist, NP, PA, vet, PT, etc., is NOT.

Seriously, using the title PHYSICIAN is often highly restricted by state law, but in some cases, is permitted to be used by DCs and ODs and even some PhDs. Don't do it and avoid the potential confusion and liability.

If you're not ashamed of being an OD, then proudly say "I'm an optometrist" or "I'm a Doctor...of Optometry." You are NOT an optometric physician or medical optometrist no matter how many residencies you've gone through or how liberal your med practice statute is. You're an optometrist. Be proud of what you are and don't mislead others by puffing yourself up to be something else. It's sad that physicians often garner more respect from patients, but that's the nature of health care. As more professions upgrade and gain increased scopes of practice, the "prestige" of medicine will subside. It aleady has significantly!

The impetus behind this Bill, besides obvious professional insecurity, is MANY (not all), but MANY (and usually not ODs) health professionals, especially chiros, go around insisting on being called DOCTOR by everyone, even outside of work-settings, and will actually say they are "doctors" rather than chiros, pods, etc. This confuses many patients and leads many to believe that DCs, ODs, and others can practice medicine -- or at least practice outside the scope of their licensure.

Look at many ads in the paper or phone book. I saw one a few months ago with an audiologist. Dr. Bob Jones, Clinical Audiologist -- Dr. Jones is an audiolgist who specializes in bla bla bla and PRESCRIBES hearing aids and TREATS patients with bla bla bla..." In other words, this quack capitalized on his title and used targeted words to attract attention of lesser informed patients who are going to assume he's an ENT or something. This Bill would make this type of misleading advertising illegal, or least impose a fine. If I were the attorney for the aforementioned audiologist, I would advise: "Bob Jones, Au.D. (Doctor of Audiology), is an audiologist who specializes in fitting clients with hearing aids and conducting hearing exams." Simple, no misleading ads, and honesty-in-fact. How can you go wrong there?

The public assumes "doctor" means physician. This is stupid and incorrect, but because it is the case, optos should NOT go around using the title without qualifying it. Also, outside of your work-setting, don't you think it's a little pompous and...lame? I'm an MD and sometime after residency, the mystique and "power" of being called "doctor" wore off and I really didn't care. I prefer my patients to use the title, but outside of work, I'm not going to soil myself if someone...shudder...calls me MISTER!!!!!!!!!

I wonder if you guys would have your panties in a knot if this Bill were designed to keep lawyers, who earned a JD degree, 3-4 years of study AFTER a complete bachelor's degree, from using the title "doctor", which they technically could start doing if they chose to?

Originally Posted by exmike
Here is the question. If a guy had a acute MI on the side of the road and someone turned to you and asked you "are you a doctor??". What would you say? I argue that in that situation, only a physician (MD/DO) would be able to say "yes". Any other "doctor" professional that says 'yes' would be misrepresenting him/herself. It is obvious from the context that doctor implies medical doctor

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jefguth said:

This is an interesting scenario. Honestly, I'm not sure how I would respond to the question, I guess saying "no" would require less explanation. While obviously as an optometrist I would not be a physician, which is what this person is looking for, but in the scenario just about any licensed health care provider should be able to render some level of assistance via CPR. Now this is not a loaded question; but would an MD who happens to be on the scene without any specialized insturments or medications really be in the position to do much more for this person. Obviously I would expect the MD to have more experience with such a situtation, but given the circumstances I would imagine not much can be done until this person makes it to the ER. Just curious, please excuse any ignorance I may have just revealed.



I have to wonder how the DDS would respond to the situation. Like OD's they most likely would not have had the experience of handling a MI like that, but like other providers they are required to be certified in CPR and have an ethical obligation to provide assistance. I'm sure it would be ideal to have a physician onsite that has experience managing MI, but given you are talking about the side of the road its hardly ideal circumstances. Which makes me wonder, if in such a situation the DDS is no more a "doctor" (as in medical doctor) than an OD, why is it that medicine and dentistry have aligned themselves behind this bill? My guess is political manouvering.

Certainly your scenario is an interesting one that makes us wonder how we would respond, but how relevant is it really to the day to day patient-provider relationships in health care and the use of a title. For sure noone is concerned about how they are addressed or how they address themselves when there is the more importan matter of a person suffering a MI next to the road. Upon further thought, I might have to agree that saying "yes" approaches a misrepresentation - so I would say "no," but quickly add that I'm am certified in CPR and obligated to assist.

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As a physician and lawyer, I can tell you that this situation does arise from time-to-time and that if you're an optometrist, you better, no matter how much CPR training you've had, keep your mouth shut and answer NO. Whoever is asking for help is seeking QUALIFIED MEDICAL help, not an optometrist. Seriously, not to demean your degree, but if the guy's eye was just enucleated, and someone asked for a "doctor", you need to keep your mouth shut and answer NO. You couldn't possibly treat that type of injury. Even a vitreous bleed, or something like that, you wouldn't be qualified to treat. If you answered YES to the guy with the MI, or the guy with the enucleated eye, you are looking at three possible bad consequences:

1) Significant pecuniary loss secondary to civil litigation (i.e., you're gonna take it up the ass in court);

2) Loss of professional license due to misrepresentation and fraud as well as numerous other professional conduct/ethical violations; and,

3) Criminal charges for practicing medicine without a license, or detrimentally inducing others to believe you are qualified to practice medicine.

The same would hold true with the dentist, podiatrist, pharmacist, vet, psychologist, etc. However, an NP, PA, or even many RNs, would be more than qualified to attempt to offer some assistance (assuming they said, "No, I'm not a doctor, but I'm a nurse practitioner or PA or nurse."). ANY licensed physician, regardless of specialty, would be able to render some kind of medical assistance to the patient and would be sheltered from the above legal consequences due to state enacted tort "good samaritan" statutes that shield physicians, EMTs, PAs, and nurses from negligence and other civil damages if they act in good faith and do not act in a reckless manner while attempting to help.

An OD who tries to offer help to some poor schmuck having an MI is a complete ***** and COULD lose everything if he screws up. An OD or DDS or PhD or DVM or PharmD will NOT be sheltered under any good samaritan statutes.

About 10 years ago, a friend of mine represented a client who suffered an asthma attack on airplane. The client, an otherwise healthy man, was status asthmaticus and needed a bronchodilator. His sx's were not typical for asthma, and one of the flight crew asked for a "doctor". Some idiot veterinarian wanted to stroke his ego and answered "I'm a doctor" and "I can help", and after his expert "help", the victim's larynx was damaged beyond repair, and he ended up deformed. Even after cosmetic surgery, he was disfigured and had long-term dysphagia.

The vet lost is license, was prosecuted by federal authorities (airspace = federal jurisdiction), and was sued for everything he had, which wasn't much since he only made 50K a year 10 years out of school.

My point, in situations like the one described in this scenario, keep your mouth shut and let properly trained personnel respond.

Optometrists are held to the same standard of care as ophthalmologists. If I were to advertise Dr. Paul Smith, I must by state law say that I'm an optometrist.

jefguth said:

Likewise, I share your disdain for the optometric, chirocraptic, etc physcian titles. Personally I just think it sounds stupid and awkward. Plus why do we need another title for a small profession the public still knows nothing about?

However, I had always thought that practioners would be held to the same level of care as a physician regardless of the title used. Afterall, if an optometrist is defending a malpractice case 9 times out of then there will be a fellowship trained subspecialty ophthalmologists testiflying against the care rendered by the OD. Likewise for anyother providers. Is there a precedent somwhere in which a DC or somone else would have lost their civil case because they called themselves a chiropractic physician?

Thanks for the insight btw!

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Oh, no, no, no. Remember one thing, if you're an OD and you're sued for malpractice, under NORMAL circumstances, you will be held to the standard of care of optometrists nationwide. In other words, if you're in Michigan like me, let's say somewhere rural, and you screw up and get sued, you'll be held to the same standard of care as other ODs in MI, OH, NJ, etc. They won't compare you to just rural MI optos. It's a national standard of care standard, but the medical experts used to testify about the standard of care and negligence/potential negligence, will be optometrists who will discuss common optometric practice and how the defendant OD either did or did not comport with the standard of care.

Now, an MD can testify about the extent and nature of an iatrogenic ocular injury (physician or optometrist-induced), or the nature and extent of a medical condition that was exacerbated by an OD's negligence. That is expert testimony about the medical issue, not about the standard of care. An MD should never be allowed to testify about an optometric standard of care. If the defense doesn't object, you got yourself legal malpractice!

If you're an OD, and are defending a suit for malpractice, PhDs and MDs can be used to testify about other issues related to the case, such as PhD economists testifying about the extent of the plaintiff's financial loss due to his vision loss, or a PhD psychologist who testifies about the psychological trauma incurred by the injury the optometrist caused. MDs can testify about the nature and cause of the injury and can even explain to the jury what the OD did wrong to cause it, etc.

HOWEVER, if an OD holds himself out as a physician, it is possible, not guarnateed, but possible, that he could be held to the same standard of care as a PHYSICIAN, not an optometrist. Remember, under normal circumstances, an OD is held to the national standard of care as other optometrists. This standard is defined by your professional associations, training, custom, practice, and scope of practice. If you hold yourself out as an optometric physician, and cause a patient harm, you could be deemed to have acted willfully and wantonly and thus held to the the physician standard of care -- even, and this is the kicker, if your state permits you to use the title optometric physician.

If that happens, put a fork in yourself because you will be DONE.

In the yellow pages in my area some chiros and optoms have their ads with STETHOSCOPES around their neck. This is blatant misrepresentation and this **** needs to stop. Be proud (or accept) what you are and stop misleading the unsuspecting public. Also, almost all optoms advertise LASIX (but conveniently leave out the part they only do pre and post care and that the actual LASIK will be referred out to an MD), again more example of blatant misrepresentation.

HOLLYWOOD said:

Optometrists are held to the same standard of care as ophthalmologists. If I were to advertise Dr. Paul Smith, I must by state law say that I'm an optometrist.

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No. Optometrists are NOT ophthalmologists, so why would they be held to that standard of care? We're talking liability issues here. If you say Dr. Paul Smith, yes, you must qualify that you are an optometrist. Dr. Paul Smith might be somewhat ambiguous, and perhaps a tad deceptive (e.g., playing on the uninformed public's misconception that "doctor" = physician), but if you don't use the term physician in your ad, you will be held to the same standard of care, in a suit, as any other optometrist.

As a good rule of practice, avoid ambiguity and be clear about your training and profession. How do you avoid confusion? Simple: Paul Smith, O.D., Optometrist. Some people prefer: Paul Smith, Doctor of Optometry. Use your name followed by your degree and then clearly spell out what you are (e.g., chiro, optometrist, pharmacist, etc.). NEVER get cards or letterheads saying Dr. John Smith. Stupid. Will doing that up the standard of care? Most likely not, but it could if a jury finds that such advertising intentionally misled folks into using your services because of the false belief that you were an MD or DO.

However, there is precedent out there showing that ODs and DCs and others who have intentionally incorporated the term "physician" into their advertising or practice either know or should know that such a term creates a false perception in the minds of some people that they are being seen by a medical doctor. Best way to avoid that is by eliminating such patently false titles and sticking with optometrist, chiropractor, etc. You'll ever be held to the standard of an MD if you act within the scope of your practice.

FamilyMD said:

In the yellow pages in my area some chiros and optoms have their ads with STETHOSCOPES around their neck. This is blatant misrepresentation and this **** needs to stop. Be proud (or accept) what you are and stop misleading the unsuspecting public. Also, almost all optoms advertise LASIX (but conveniently leave out the part they only do pre and post care and that the actual LASIK will be referred out to an MD), again more example of blatant misrepresentation.

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These people should be reported to their respective professional boards, which no doubt regulate how the profession is allowed to advertise. Usually, as with lawyers, as long as an ad does not provide false or misleading information, the professional is safe from professional ethics sanctions, but if an OD or DC posted an ad with a stethoscope in the background, or around their neck, that's...just wrong, but I'm not sure if it's illegal or unethical...just wrong.

Usually, the ads are punished when they start to claim to have certain medical skills or powers which they clearly do not have.

FamilyMD said:

In the yellow pages in my area some chiros and optoms have their ads with STETHOSCOPES around their neck. This is blatant misrepresentation and this **** needs to stop. Be proud (or accept) what you are and stop misleading the unsuspecting public. Also, almost all optoms advertise LASIX (but conveniently leave out the part they only do pre and post care and that the actual LASIK will be referred out to an MD), again more example of blatant misrepresentation.

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Optometrists advertise diuretics in your phone books?

aphistis said:

Optometrists advertise diuretics in your phone books?

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Yes I caught this but was too lazy to edit

if some guy has a heart attack and someone asks for a doctor and you are an optometrist, run dont walk, away! Lets say in crazy world ODs achieve the respect of MDs and the educated public see ODs as doctors as physcians, what has changed? Nothing. OD training is for diagnose and treatment of the eyes, not dealing with a heart attack. Likewise, would a MD who after many years is hazy on dealing with a heart attack rush forward and startiing trying to treat the guy? It is all about DOING WHAT YOU ARE COMPENTLY TRAINED FOR. heck say a guy comes in for refraction and you have done "medical optometry" exclusively for years and have forgotten refracton...RUN (refer out). This is about ethics and has nothing to do with turf wars and titles. its the patient's life/health at sake. I dont know why this hypothetical situation is being debated!

Thanks for the references to the phonebook and i too have proceeded to look through them. and yes i see the guy with a stealthscope (not an OD though but not a medical doctor). Now that is just weird advertisement! that is like a surf shop showing a picture of a (non surfing) donkey. I think the state association should patrol the advertisments and fine (or at least reprimand) ODs using "weird" ads.

Again, i would like to say that i fully support suspension of license (at least) for ODs caught claiming they are MDs. However "misleading" statements by ODs are of concern. Here Ods are only hurting thier profession by pretending to be something else. say you dont get caught, but how is the public to respect ODs if they think thier awesome eye examine was performed by an MD? The law (or the optometry association) should require SPECIFIC titles for "doctors." This should apply to everyone, Doctor of Pharmacy, Doctor of Optometry, Medical Docter etc. In addition, if there is a "speciality" then one needs to put that in there too! "Optometrist" "Pharmacist" and yes "Family medicine" "Opthamologist" "Internist" etc. Those caught convienently leaving something else needs to be FINED AND PUNISHED. What should the exact line look like ? AOA DO SOMETHING what are ODs paying you for?
something like requiring the words "Doctor of Optometry" or "OD" AND "Optometrist" somewhere in their ad. and no "i am john doe a doctor" and in small print "optometrist" is not acceptable!

for liability, thanks prozac, that was a well written explanation for us non JDs!

ProZackMI said:

These people should be reported to their respective professional boards, which no doubt regulate how the profession is allowed to advertise. Usually, as with lawyers, as long as an ad does not provide false or misleading information, the professional is safe from professional ethics sanctions, but if an OD or DC posted an ad with a stethoscope in the background, or around their neck, that's...just wrong, but I'm not sure if it's illegal or unethical...just wrong.

Usually, the ads are punished when they start to claim to have certain medical skills or powers which they clearly do not have.

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I am an MD so much of what you are writing doesn't directly apply to me, but I must say your postings are likely the most imformative I have read on this website. Thanks.