ABO kills Retina FPD

[hello lady!]

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Certainly an interesting back and forth regarding scope.

The one thing is that these thoughts about specialist vs comp are always brought up in a vacuum:

Is a retina specialist able to tease out nuances that aren't even on my radar as a comp doc? No doubt. Would I prefer my patient go to retina for injections / eval? Sure - so much easier for me.

But would I prefer my patient go to the local private equity-owned retina group who schedules literally 120 patients per doctor per 8 hour day? That isn't even an exaggeration. Patients wait 4+ hours for their 180 seconds with the doc and they come out livid and often skip visits because of this. Can that retina doc really think about such nuance with so many visits in a day? I doubt it

I believe the docs that participate in online forums here or reddit etc tend to be more thoughtful about their clinical care. If we were all under the same roof we'd probably have a great diverse center with great patient care. But unfortunately, for every one of us here, there are way more providers out there in the real world just churning and churning - with the patient as an afterthought. It's just like the cataract docs pushing FLACS/Multifocals on everyone, often inappropriately. Other than malpractice lawyers there really is not a real system to police this bad behavior.

If sticking with the comprehensive doc who the patient trusts increases compliance - there's something to be said there. If it's easier for the patient to go to one doctor to get a refraction + visual field for glaucoma + injection - all with one copay? That's a win for the patient. Going to an OD for refractions + glaucoma guy for fields + retina for injections can be very expensive and logistically difficult, even though technically they'd have the "biggest expert in each condition."

 

[dantt]

Certainly an interesting back and forth regarding scope.

The one thing is that these thoughts about specialist vs comp are always brought up in a vacuum:

Is a retina specialist able to tease out nuances that aren't even on my radar as a comp doc? No doubt. Would I prefer my patient go to retina for injections / eval? Sure - so much easier for me.

But would I prefer my patient go to the local private equity-owned retina group who schedules literally 120 patients per doctor per 8 hour day? That isn't even an exaggeration. Patients wait 4+ hours for their 180 seconds with the doc and they come out livid and often skip visits because of this. Can that retina doc really think about such nuance with so many visits in a day? I doubt it

I believe the docs that participate in online forums here or reddit etc tend to be more thoughtful about their clinical care. If we were all under the same roof we'd probably have a great diverse center with great patient care. But unfortunately, for every one of us here, there are way more providers out there in the real world just churning and churning - with the patient as an afterthought. It's just like the cataract docs pushing FLACS/Multifocals on everyone, often inappropriately. Other than malpractice lawyers there really is not a real system to police this bad behavior.

If sticking with the comprehensive doc who the patient trusts increases compliance - there's something to be said there. If it's easier for the patient to go to one doctor to get a refraction + visual field for glaucoma + injection - all with one copay? That's a win for the patient. Going to an OD for refractions + glaucoma guy for fields + retina for injections can be very expensive and logistically difficult, even though technically they'd have the "biggest expert in each condition."

Amen.

Let me put out there that there's no way I'm going to do a refraction + visual field + injection all in one visit so the patient can pay one copay. The patient will pay their refraction money cash only and get their glaucoma visit + visual field. Not going to also inject with a modifier 25 and have it rejected and audited anymore than do SLT both eyes at the same time to make 50% less on the 2nd eye. (can you imagine paying double click fee for DSLT? LOL) They will have to come back another day and pay another copay until we can bill and collect full payment for each item.

 

[eyeeye_captain]

This is crazy

At least the comp docs actually have licenses and real training.

Boy howdy is there a lot to unpack there with the OD. Her prior national president dad pushed some state thing through after she failed her national exams, then she allegedly went on to blast someone’s macula.

 

[davidxavi]

Rural patients and access to care are the exact same arguments that optometrists make to be able to practice comp ophthalmology in urban areas..

 

[docdoc2012]

Rural patients and access to care are the exact same arguments that optometrists make to be able to practice comp ophthalmology in urban areas..

And once again, do you not see a difference between a comprehensive ophthalmologist who is an ant segment surgeon doing an injection vs. an optometrist?

 

[RetinaDude]

And once again, do you not see a difference between a comprehensive ophthalmologist who is an ant segment surgeon doing an injection vs. an optometrist?

Yes, all of us on this forum know the difference, and we are not who that argument is for (or against). It’s a statement, made by ODs, for political purposes. The majority of ODs probably realize it’s not a good idea either, because they know the limits of their training, but politicians won’t care

 

[docdoc2012]

Yes, all of us on this forum know the difference, and we are not who that argument is for (or against). It’s a statement, made by ODs, for political purposes. The majority of ODs probably realize it’s not a good idea either, because they know the limits of their training, but politicians won’t care

If it keeps being brought up in this discussion, then obviously those bringing it up think it carries a counterweight argument. Scope expansion is a problem across specialties. Politicians obviously dont care about the difference. We know this.
A majority of ODs will not want to do intravitreal injections and want nothing to do with the retina beyond charging people for optos photos and sending us 'melanomas' that are vortex veins.
If we want to be concerned about scope expansion, lets tackle what our own colleagues in florida are doing- physician assistant injectors anyone?

 

[eyeeye_captain]

physician assistant injectors

I think Kaiser was looking into that a while back. They had a presentation at some meeting where there they had a PA who only did injections - no OCT interpretation, postops, etc. Just keep and shoot.

I doubt many PAs would (maybe) take a pay cut to do nothing but slam injections. They’d lose their minds with the boredom. It’s not like it saves that much productive clinic time anyway if you have a decent workflow and aren’t absolutely slammed. How much help do you need?