A Modest Proposal. OD-OMD training as 3rd Way

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

linevasel

Junior Member
20+ Year Member
Joined
May 24, 2005
Messages
108
Reaction score
74
I started new thread, because I liked Core Dome Ahs proposal and the clarity with which he described the challenges being created by oversupply of optoms, but…. For reasons all too familiar, it kind of devolved into a trolling-accusation war – which wasn’t really fair to Core Dome Ahh.

It might be advantageous to the profession to create a few limited optom-to-OMD training positions—similar to the DDS/DMD – OMF track that require dentists to get their medical degree. Make it a 4-5 year program – 2 (or 3 ) years med school, 2 years med/surgical OMD residency). You create 10 positions across the nation. It would be super competitive, and consequently select for the most ambitious/capable optoms. It would allow ophthal to pre-emptively influence the inevitable scope-expansion wars. And lets face it…. Some optoms simply made a dreadful mistake by going to optom schoo. They thought they were comfortable with limited scope and now realize they want to do more. Telling them to go back to med school and retrain as OMDs isn’t a solution. Those optoms will just work at creating loopholes/openings at the legislative level. (Shout-out to PBEA! & Ian Benj Gaddie!).

Disclaimer – I’m a lowly Prelim with no real-word ophtho experience, a degree in economics, and an interest in market equity and efficiency. But 50 years from now, might this not be our saving grace?
 
Except that there is no shortage of ophthalmologists and there is no reason to create another path to make more ophthalmologists. I know of some ophthalmologists in saturated areas seeing who sit around doing nothing half the day and can only find 10-15 surgeries to do per year. Creating more providers simply increases the cost of health care because they will "create" more work for themselves if they have nothing to do. (example - a patient with a simple stye is told to make a follow up visit in 6 weeks when he could have just been told to come back if it doesn't get better).

Also, a 2 year med/surg residency is not long enough to learn how to diagnose and treat ophthalmic diseases and surgery. Even after a 4 year residency, most of us still do a fellowship to learn how to treat certain diseases properly.
 
Except that there is no shortage of ophthalmologists and there is no reason to create another path to make more ophthalmologists. I know of some ophthalmologists in saturated areas seeing who sit around doing nothing half the day and can only find 10-15 surgeries to do per year. Creating more providers simply increases the cost of health care because they will "create" more work for themselves if they have nothing to do. (example - a patient with a simple stye is told to make a follow up visit in 6 weeks when he could have just been told to come back if it doesn't get better).

Also, a 2 year med/surg residency is not long enough to learn how to diagnose and treat ophthalmic diseases and surgery. Even after a 4 year residency, most of us still do a fellowship to learn how to treat certain diseases properly.

By most reports, there will be a future shortage of ophthalmologist based on: 1. retiring physicians. 2. aging population/baby boomers coming of age 3. newly graduated ophthalmologist practicing part time and perhaps having shorter careers

What you notice in saturated markets is not the case for a large part of the country that is actually under served.

All that said, I would propose expanding the number of residency spots for MD grads before we open up the floodgates to optoms. Year after year, highly competitive, qualified and deserving candidates from MD programs do not match into ophthalmology because of its highly competitive nature. Why in the world would we want to make this process even more competitive by adding optom students to the pool of applicants?

If there were a shortage of qualified MD applicants, perhaps OP's proposal would be reasonable. But at this point, if there is an expansion of residency spots, I would much rather see these go to highly qualified MD graduates.
 
Last edited:
I started new thread, because I liked Core Dome Ahs proposal and the clarity with which he described the challenges being created by oversupply of optoms, but…. For reasons all too familiar, it kind of devolved into a trolling-accusation war – which wasn’t really fair to Core Dome Ahh.

It might be advantageous to the profession to create a few limited optom-to-OMD training positions—similar to the DDS/DMD – OMF track that require dentists to get their medical degree. Make it a 4-5 year program – 2 (or 3 ) years med school, 2 years med/surgical OMD residency). You create 10 positions across the nation. It would be super competitive, and consequently select for the most ambitious/capable optoms. It would allow ophthal to pre-emptively influence the inevitable scope-expansion wars. And lets face it…. Some optoms simply made a dreadful mistake by going to optom schoo. They thought they were comfortable with limited scope and now realize they want to do more. Telling them to go back to med school and retrain as OMDs isn’t a solution. Those optoms will just work at creating loopholes/openings at the legislative level. (Shout-out to PBEA! & Ian Benj Gaddie!).

Disclaimer – I’m a lowly Prelim with no real-word ophtho experience, a degree in economics, and an interest in market equity and efficiency. But 50 years from now, might this not be our saving grace?

Sorry bra, too bad you couldn't get into med school and had to settle for optom school. ^^ will never happen. :laugh:
 
Sorry bra, too bad you couldn't get into med school and had to settle for optom school. ^^ will never happen. :laugh:

Hmmm, idk if you read the original poster's whole post, but it sounds like he or she's a prelim who's starting ophtho residency in 2014. Also it seems pretty unfair to assume all optom's were hoping to go into med school, i'm sure are there are some that could've gone to med school but had thought at the time that optometry fit them best.

(going with the analogy of the original post) It could be much like some people who do OMFS after dental school who may have thought originally that dentistry alone was what they wanted. The main problem with the analogy is that OMFS does have a bit of a niche in medicine (although certainly some overlap with ENT and Plastics), whereas graduates of the proposed OD-MD pathway would probably not be performing procedures that are not already done by ophthalmology. So it would be harder to convince old-school ophtho chairs at medical institutions the necessity of such a pathway, compared to how the DDS-MD were developed.

Speaking as an ophthalmology residency applicant, I have respect for the training that OD's received, and I do agree with the original post that giving OD's a path that does not involve the full 8+ years of training that we start after college is certainly reasonable. I think OMFS gives DDS's approx ~2 years off of the pathway (1 year less of med school + 1 year less of residency, based on my med school's program at least), which is not terrible. As I said above tho, the main difference between the fields in whether such a program would create a true niche among what already exists in medical practice, or if you're creating too much of a "back-door" to ophthalmology that ophthalmology faculty would be opposed to supporting. So making this idea reach fruition seems difficult, but trying to bring OD's and MD's together in something along these lines does seem like a better path in the future than us just clawing each other to death in legislative and other avenues.
 
By most reports, there will be a future shortage of ophthalmologist based on: 1. retiring physicians. 2. aging population/baby boomers coming of age 3. newly graduated ophthalmologist practicing part time and perhaps having shorter careers

There definitely is NO shortage of eye care providers out there. Tons of ophthalmologists and even more optometrists out there. Ever wonder why young Ophthalmologists have a difficult time finding a job? It's because there are too many of us, especially in the more attractive areas of the country to live.

Why the heck would you want programs to pump out even more ophtho graduates? Do you only want to do 2 phacos a week or something and earn less than 100k? Optometry is already facing a huge surplus of providers given the opening of new (and unnecessary) optometry schools. Dermatology graduates are loving life because they are always in demand -- a direct function of them limiting their number of graduates.
 
Hmmm, idk if you read the original poster's whole post, but it sounds like he or she's a prelim who's starting ophtho residency in 2014. Also it seems pretty unfair to assume all optom's were hoping to go into med school, i'm sure are there are some that could've gone to med school but had thought at the time that optometry fit them best.

(going with the analogy of the original post) It could be much like some people who do OMFS after dental school who may have thought originally that dentistry alone was what they wanted. The main problem with the analogy is that OMFS does have a bit of a niche in medicine (although certainly some overlap with ENT and Plastics), whereas graduates of the proposed OD-MD pathway would probably not be performing procedures that are not already done by ophthalmology. So it would be harder to convince old-school ophtho chairs at medical institutions the necessity of such a pathway, compared to how the DDS-MD were developed.

Speaking as an ophthalmology residency applicant, I have respect for the training that OD's received, and I do agree with the original post that giving OD's a path that does not involve the full 8+ years of training that we start after college is certainly reasonable. I think OMFS gives DDS's approx ~2 years off of the pathway (1 year less of med school + 1 year less of residency, based on my med school's program at least), which is not terrible. As I said above tho, the main difference between the fields in whether such a program would create a true niche among what already exists in medical practice, or if you're creating too much of a "back-door" to ophthalmology that ophthalmology faculty would be opposed to supporting. So making this idea reach fruition seems difficult, but trying to bring OD's and MD's together in something along these lines does seem like a better path in the future than us just clawing each other to death in legislative and other avenues.

Good thing you're not in charge 👍
 
Sorry bra, too bad you couldn't get into med school and had to settle for optom school. ^^ will never happen. :laugh:

Good thing you're not in charge ��

Sorry to break it to you, *bra*, but you're kind of a tool.

And not just from what I've seen in here. Maybe you should at least match before you get all cocky?
 
Hmmm, idk if you read the original poster's whole post, but it sounds like he or she's a prelim who's starting ophtho residency in 2014. Also it seems pretty unfair to assume all optom's were hoping to go into med school, i'm sure are there are some that could've gone to med school but had thought at the time that optometry fit them best.

(going with the analogy of the original post) It could be much like some people who do OMFS after dental school who may have thought originally that dentistry alone was what they wanted. The main problem with the analogy is that OMFS does have a bit of a niche in medicine (although certainly some overlap with ENT and Plastics), whereas graduates of the proposed OD-MD pathway would probably not be performing procedures that are not already done by ophthalmology. So it would be harder to convince old-school ophtho chairs at medical institutions the necessity of such a pathway, compared to how the DDS-MD were developed.

Speaking as an ophthalmology residency applicant, I have respect for the training that OD's received, and I do agree with the original post that giving OD's a path that does not involve the full 8+ years of training that we start after college is certainly reasonable. I think OMFS gives DDS's approx ~2 years off of the pathway (1 year less of med school + 1 year less of residency, based on my med school's program at least), which is not terrible. As I said above tho, the main difference between the fields in whether such a program would create a true niche among what already exists in medical practice, or if you're creating too much of a "back-door" to ophthalmology that ophthalmology faculty would be opposed to supporting. So making this idea reach fruition seems difficult, but trying to bring OD's and MD's together in something along these lines does seem like a better path in the future than us just clawing each other to death in legislative and other avenues.

this, well-said. 👍
 
Sorry to break it to you, *bra*, but you're kind of a tool.

And not just from what I've seen in here. Maybe you should at least match before you get all cocky?

Chill. This is just the internetz. Most of my posts are serious and helpful, while some are joking around. Such trying to fit into the SDN community, which is full of braz.
 
I can appreciate:
1) There is no unique OD-OMD niche. OD, OMDs would basically just be practicing as Ophthalmologists – unlike the DDS, MD docsaintjustadoogie.
2) Young ophthalmologists (particularly in "desirable" cities) have problems finding jobs with decent starting salaries. - DUSN, LIGHTBOX
3) The last thing any specialty wants to do is create surpluss of providers because the price of labor is driven down, and in healthcare – excess providers create their own demand (which on a macro-level is wasteful). - AINTJUSTADOOGIE, DUSN

But without thinking through all the logistic headaches that my proposal would engender, I'm not sure that any state legislative body would find any one of these reasons persuasive enough, particularly when most legislative bodies don't really understand the differences between OD, and OMDs other than OMDs do surgery. Before med school, I wasn't really quite clear on the differences either. Started MS1 thinking OMDs were primary eye doctors & surgeons, now it seems the understanding has shifted and that both ODs and OMDs are primary eye doctors? I'm pretty sure that now as a PGY1, some of the differences still elude me (I hate to admit it, and I hope I don't get slammed for that statement). Either way, I don't think this is a consumer driven proposal. Patients aren't clamoring for ODs-OMDs. But I see it more as a valve to help ease/moderate the growing demand for expanded practice privileges. Every medical specialty that has faced this turf-challenge from non-medical providers has essentially lost or is in the process of losing. I don't doubt that the distinct differences can be maintained particularly for sub-specialists and cataract surgery. But when it comes to comprehensive/medical ophtho, I wonder if we haven't already reached the tipping point. Hopefully, this isn't the case. Predicting the future is a fool's errand after all. But, I'm getting the feeling that future responses to these challenges ( Creating Ophthalmic Assistants or combined training-paths) will need to fall a bit more outside the box.
 
To Mstaking10 -

I never really considered that angle, and it gives me pause. I suspect most OMDs would agree that creating a backdoor to ophthalmology that is only open to ODs is an injustice. But most of this proposal really hinges on your future outlook. If you think the tension will persist indefinitely, and this "expansion" problem will operate as a perpetual thorn in the OMD's side, then I completely agree. No backdoor. But if you think--as I do--- that eventually OMDs will lose this "battle" then injustice or not, we would be better served by seriously considering something along these lines (assuming you agree it would put the expansion-of-privileges question to rest...)
 
We shouldn't worry about 50 years from now.

Right now, there appear to be enough ophthalmologists and more than enough optometrists. I do not hear of everyone universally being booked out eight weeks and not being able to hire an associate for anything less than crazy money. Until that happens, a third pathway hardly seems necessary.

Setting all that aside, could you imagine a third pathway? Maybe. Dentists who do OMFS often find themselves with an additional M.D. degree after doing their residencies, and without going through four years of medical school. Of course, you could argue that they do not represent any practical third pathway because there are so few of them compared to the total numbers of dentists but also because there is no other pathway to their particular specialty, with or without a supplemental M.D., (even if you can say that ENT-Skull-Base and Plastic Surgery compete for the same patients.)
 
Those optoms will just work at creating loopholes/openings at the legislative level. (Shout-out to PBEA! & Ian Benj Gaddie!).

My point regarding "legislation" was that if OD scope of practice was decided soley by MD's we would be limited to refraction....because basically that is all you think we are good for. Any other medical concerns and we place pts at risk because "we don't know what we don't know"....doesn't that about sum it up? That is why we have legislation, not "loopholes", but legitimate legislation to allow us to practice what we trained for. Personally, for me that is 😉, that does not include surgery, but it does include the full range of diagnosis and most other medical tx's.
 
To Mstaking10 -

I never really considered that angle, and it gives me pause. I suspect most OMDs would agree that creating a backdoor to ophthalmology that is only open to ODs is an injustice. But most of this proposal really hinges on your future outlook. If you think the tension will persist indefinitely, and this "expansion" problem will operate as a perpetual thorn in the OMD's side, then I completely agree. No backdoor. But if you think--as I do--- that eventually OMDs will lose this "battle" then injustice or not, we would be better served by seriously considering something along these lines (assuming you agree it would put the expansion-of-privileges question to rest...)

That's a big assumption. Say you open up 10 slots for highly competitive optoms to residency. Will that be sufficient? Or will there be calls for slots increased to 15, 20, 30 etc.? Will older optoms who wish to do procedures want to go that route, or will they continue to fight for privileges without having to go back and do residency later in life, particularly if they are already well established and not looking forward to taking off 2-3 years for additional training? Perhaps some would argue residency is not necessary to just to lasers or injections and would continue to call for privileges without the need for residency.

Just a few thoughts, but I'm sure there are other limitations.
 
By most reports, there will be a future shortage of ophthalmologist based on: 1. retiring physicians. 2. aging population/baby boomers coming of age 3. newly graduated ophthalmologist practicing part time and perhaps having shorter careers

What you notice in saturated markets is not the case for a large part of the country that is actually under served.

I've seen those reports too and I don't buy them. The vast majority of the country has an over saturation of ophthalmologists. There are really very few areas that don't have access, and those are generally areas that simply don't have the population to support an ophthalmologist.

I know this b/c I was recently in the job market and the job offers for most rural areas really weren't that great. You had to go to a very very very rural area to get a job offer that's significantly better than the typical new associate's contract in metropolitan locations.
 
Disclaimer – I'm a lowly Prelim with no real-word ophtho experience, a degree in economics, and an interest in market equity and efficiency. But 50 years from now, might this not be our saving grace?

Nope, there is no way optoms are going to ever be doing a significant amount of cataract surgery. It's a lot harder than it looks, and the reimbursement is very low. Unless you're doing a lot of them very efficiently there would no economic point to doing them at all.

And that's pretty much the same issue with most surgeries these days. Ask yourself, why do the vast majority of comprehensive ophthalmologists refer out PK's, trabs, tubes, and blephs? We were all trained to do them as residents! Simple economics, it's just not worth the time, overhead, and stress unless you're cranking lots of them out.

And there is absolutely no reason to allow optoms a path to ophthalmology b/c we're already turning away med students in droves, and yet are still over saturated in the vast majority of the country.
 
I'd like to know specifics about where these undersaturated areas are because I'd consider moving there. Other than one place in Kansas, I did not see a whole lot of these undersaturated areas on the job interview trail.
 
I'd like to know specifics about where these undersaturated areas are because I'd consider moving there. Other than one place in Kansas, I did not see a whole lot of these undersaturated areas on the job interview trail.

Should be easy: 1) find a place with less-than-year-round-sunny weather; 2) at least 1 hour from metropolitan city; 3) at least 2 hours from a coast.

You should find plenty of open jobs out there with that simple criteria search 🙂
 
While there may be relatively better offers in those locations, there are some essentials.
1. A decently well-off community with a reliable employment base. No one-company towns; the risk of having your patient base lost with a closure of a plant or office is too great for the personal investment. 2. Decent tax base: no basket case communities that can't support their schools and public services locally. 3. A hospital that is well-capitalized with a growth trend. That requires a well-rounded medical community of generalists and enough patients who use the facilities to keep it in the black.
4. A decent housing stock and solid middle-class economy: goes without saying. Upscale options are nice and all, but the middle class households are what carry the communities. 5. Not too much welfare: you do not want to be somewhere seen as a section-8 gulag or a place where the only medical clinics are FQHCs. That is not good for obvious reasons, not least of which is that those places are seen as unattractive to self-supporting businesses (not counting the marginal companies that are always trying to get ridiculous tax-exempt status for promising jobs) and usually suffer the consequences of poor resources for municipal services.
 
Top