Should Eye Medicine be Vertically Integrated?

If opticians wanted to refract, they should have gone to college and optometry school.

If optometrists wanted to perform eye surgery and diagnose and treat any and all eye disease, they should have gone to medical school, completed a residency and possibly a fellowship.

No more. No less.

If opticians wanted to refract, they should have gone to college and optometry school.

If optometrists wanted to perform eye surgery and diagnose and treat any and all eye disease, they should have gone to medical school, completed a residency and possibly a fellowship.

No more. No less.

Moreover, I imagine this thread will be closed rather quickly.

theretinageek said:

If opticians wanted to refract, they should have gone to college and optometry school.

If optometrists wanted to perform eye surgery and diagnose and treat any and all eye disease, they should have gone to medical school, completed a residency and possibly a fellowship.

No more. No less.

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Agreed. In addition, moving up vertically as you stated isn't as easy as just "expanding" your role. If you want to delve more into the medical aspects, you need to have a good foundation of medical knowledge. As a starting ophthalmology resident, you're expected to already know medical diseases and illnesses like SLE, CMV, diabetes, and hypertension, and how the systemic features and eye symptoms relate. I'm not talking about the stuff on WebMD, but pathophysiology, clinical signs, treatment regiments, and complications. Ophthalmology residents already have enough on their plate learning to handle being a good clinician, what makes you think that being an optician will let you fit everything learned in school in 3-4 years? The reason we medical students have to learn about these disease before we hit the wards is that there is simply too much to learn in a short period of time.

Yes, sometimes the path is a bit much longer than it should be to have the duties of an ophthalmologist, but overall the system works. It may seem silly or harmful from your side, but I can't tell you how many times I've seen my M3 and M4 year a tech, a pharmacist, or some other medical personal trying to "expand their role" and almost severely harm or kill a patient. Once you jump through the hoops and go through the motions, you will realize why things are they way they are. If you want to do what optometrists or ophthalmologists do, you need to have the basic requisites to think and act like one.

It would seem reasonable to have the ability to shorten the MD degree from 4 years for an OD. Similar to what Oral Surgery/Dentistry do. "Test out" of the first two years using Step 1. Do clinical rotations M3/M4 with some ophtho emphasis. Then still do an intern year and 2 years of ophtho residency. It would shorten the time for an OD to go to MD from 8 years to 5.

A big thing that prevents more ODs from going to MD is the risk involved. Go through medical school and then not match into Ophthalmology. The program above they would match directly into which would help eliminate that barrier.

Commando303 said:

Well, this is what I'm talking about. Mobility within the field of eyecare would mean permitting persons to gain the additional education they need to do what more they wish to do, without having to tread from its start the entire channel toward that goal.

O.D. programs do teach a fair amount about systemic diseases that have ocular manifestations — and I, too, am not referring to bullet-point data as found on Wikipedia.org or WebMD.com. Optometrists won't be taught the ins and outs of, say, gout, but they will learn the bodily and ocular bases and implications of hypertension, diabetes, myasthaenia gravis, etc.

Vertical integration, as I favor it, would entail designing the spectrum of eye medicine such one may move within the field, directly, rather than by approaching it as if from outside. Currently, an optician who wants to earn an O.D. is treated as if he knows nothing entailed in the curriculum of an optometrist, and an optometrist who may, upon a number of years in the profession, wish to know more (medically), and to apply it, will have to navigate the M.D./D.O. program as if he is familiar with an utterly unsubstantial amount of its content.

Very few of us have an O.D. and an M.D., so it becomes tremendously difficult for someone from either arena to be deeply familiar with what is and what isn't part of the other's background; but if such things could be examined, I don't believe it's unreasonable to design a structure of eye medicince within which professional mobility is possible.

Let me pose this to the ophthalmologists: Is everything, or most of it, taught in the course of an M.D. or D.O. program relevant to your particular field? Phrased another way, could a program intended specifically for ophthalmology be significantly shorter than is the general route to an M.D./D.O.?

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From an O.D to an MD, I do agree it could be shortened. There's also a stickied thread debating this topic (though it has degraded into a flame war and is largely dead). As cme2c said, if they can pass Step 1 with good numbers and go through third year clinical rotations, yes. An ophthalmologist won't necessarily need to know the nitty gritty of OBGYN or psych but some of things learned from each rotation still serves utility as an ophthalmology resident. However, they would still need to apply and match just like any other graduating medical student as a fairness issue (else this would serve as a backdoor to ophthalmology, which you probably already realize is a very very intense field to enter). After all, why should an OD get automatic entry to an ophthalmology residency compared to a medical student who has worked hard for four years and yet not have a guarantee of matching into ophthalmology? Maybe that aspect could instead be taken care for entry of a OD into MD program.

As far as being an optician, no I do not agree for a shortened course for an MD or OD route. Being a good optician does not necessitate having the requisite skills to be a good ophthalmologist or optometrist (and with this statement I am not assuming anything about you, so don't take offense) . Ophthalmology is tied to the other fields of medicine more than one may think, and you do need to use the skills you have learned in medicine as an ophthalmology resident. I hate to use this analogy, but it's almost like a scrub tech thinking they have what it takes to be a general surgeon, simply because they know all the names of the surgical instruments and know how to scrub in and out, and all they need is a few years of school to be a surgeon because they've already seen surgeries. Compared to other applicants you would actually be at a huge advantage due to your occupation as an optician in terms of clinical experience. I've met others in similar situations as you; they were techs in an ophthalmology office and they knew a lot about how to work up patients and such. One of them is about to finish his ophthalmology residency and enter into private practice. I don't know his precise opinion about this but he has told me that he didn't think the path he took was too long (apply --> medical school --> residency).

The current system works fine. There is no need to tweak it. If you want to become an eye surgeon, go to medical school and apply for ophthalmology residency. Other professions do not have alternate routes. There is no fast-track for a paralegal to become a lawyer. Even in medicine there is no shortcut for a CRNA to become an anesthesiologist. Why should there be one in ophthalmology? Ophthalmology is a surgical subspecialty with perhaps the most overlap with other fields of medicine. To properly converse with your medical colleagues you need to go through 4 years of medical school.

theretinageek said:

If opticians wanted to refract, they should have gone to college and optometry school.

If optometrists wanted to perform eye surgery and diagnose and treat any and all eye disease, they should have gone to medical school, completed a residency and possibly a fellowship.

No more. No less.

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I totally agree!

Commando303 said:

I don't feel opticians are in any position to take a "shortcut" to ophthalmology, but I do believe they would qualify for an abbreviated course of study leading to an O.D. The medical things, they'd of cours still need to learn, but a good deal (or all) of the optics could perhaps be cut out upon successful completion of an examination of knowledge in the area.

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Despite how involved ophthalmologists are in prescribing glasses and such, the actual learning of optics is not as major part of training as one would believe. Yes you have to know optics for the OKAPs for ophthalmologists and whatever standardized tests optometrists take, but the focus is usually more on medical and clinical information. You could probably save a few months going from an optician to an optometrist, but it's probably not enough time to warrant an overhaul. The training system hasn't changed much because it works very well in creating great ophthalmologists and optometrists (for the most part). Dentistry is a bit different because the hardcore surgery components have overlap with many different fields, and even then the PGY training can stretch out to several years (not to mention that they already have go to through dentistry school).

The posters above have succinctly stated why there should be no vertical integration from being an optician to an optometrist or an ophthalmologist. I've seen some of your other posts with concerns about the future of optometry, but that should not warrant why you should be looking for such an option. Once you go through school and the entire process you'll see why we have our positions (and it's not about protecting our turf either).

Our job market is already pretty tight. Respectable jobs in many major cities is rather scarce for generalists.

Do we really need more OD to OMD flooding the job market??

Though it would make sense to have an abbreviated track from OD to MD, there is no shortage of ophthalmologist. If so, it is easy enough to increase residency spots to increase the number of graduating ophthalmologists. There is no need to change the system.

If ODs really wanted to do surgery, then I think should be worth the risk to go to medical school and then apply for medical school.

DOCTORSAIB said:

Our job market is already pretty tight. Respectable jobs in many major cities is rather scarce for generalists.

Do we really need more OD to OMD flooding the job market??

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Agreed, there are already enough ODs and OMDs to meet current demand. I'm an OD, and don't see myself as a "junior" ophthalmologist. If I decide to become an eye surgeon, I'll go to med school and compete with other MDs for residency...aint going to happen though, I'm happy as an OD, and am not one of those ODs who really wanted to be an OMD, and is bitter about not doing surgery.