ALERT: Florida optometrists gaining ground with recent bill

[immunology89]

Again, this is not a pride or ego issue. The most humble Ophthalmologists I know are not in support of bills such as these.

And you posted a comment on that article using your public facebook account. You may wish to remove that. You continue to over-expose yourself and your colleagues who you reference by name. It is your choice to have a public online identity but your acquaintances may not wish to be referenced so often.

I also disagree with your comment on that news article that these procedures are "mind numbingly easy to perform" and "a push of a button." Those are your words, and to mislead the public to believe that a procedure such as refractive surgery is simple is far more manipulative than insinuating that re-op rates are higher for ODs than MDs. If you actually have done PRK I hope you realize that holding down the button on the excimer is not the difficult part of that surgery.

I like how he started the comment on the article with "As a medical student AND a Doctor of Optometry." I'm starting to see the master plan of OD/MD. Get the MD and become a lobbyist for the optometry community. Go from state legislature to state legislature, as an MD "AND" OD testifying how "mind numbingly easy to perform" these procedures are...collecting checks in each capitol. Pretty brilliant if you ask me.

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[Slide]

Again, this is not a pride or ego issue. The most humble Ophthalmologists I know are not in support of bills such as these.

And you posted a comment on that article using your public facebook account. You may wish to remove that. You continue to over-expose yourself and your colleagues who you reference by name. It is your choice to have a public online identity but your acquaintances may not wish to be referenced so often.

I also disagree with your comment on that news article that these procedures are "mind numbingly easy to perform" and "a push of a button." Those are your words, and to mislead the public to believe that a procedure such as refractive surgery is simple is far more manipulative than insinuating that re-op rates are higher for ODs than MDs. If you actually have done PRK I hope you realize that holding down the button on the excimer is not the difficult part of that surgery.

So in his foolishness to post, I also did some cursory searching that would explain why he's so eager for this law to push.

If you do a cursory search, he filed for bankruptcy recently....hmmmmmm.....


And yes he truly is doing his medical school in he Caribbean.

 

[ophthope]

I like how he started the comment on the article with "As a medical student AND a Doctor of Optometry." I'm starting to see the master plan of OD/MD. Get the MD and become a lobbyist for the optometry community. Go from state legislature to state legislature, as an MD "AND" OD testifying how "mind numbingly easy to perform" these procedures are...collecting checks in each capitol. Pretty brilliant if you ask me.

I'm not sure when the last time a Caribbean-trained MD matched into an Ophthalmology residency program. But you could mis-use your licensure after an intern year grants you the ability to be licensed by State medical boards and operate at an ASC of your own creation to skirt Board Certification / Eligibility requirements, not telling patients that you never completed a residency in Ophthalmology. Legally, you could do a preliminary intern year and have a medical license which allows you to do so if I understand State licensure correctly. It is a complete misuse of the system but as far as I know, technically possible.

Would it be possible or legal to do that? It is my understanding that it would technically be legal for someone to do an intern year in internal medicine which would qualify them for licensure and go build their own surgery center and start doing laparoscopic cholecystectomies and hernia repairs - but nobody actually does it. Do I understand that right or am I misinformed?

 

[schmoob]

It's not really an ego check and nothing was meant in that manner. My qualifications ( as are the OD's that have advanced training on lasers and perform either SLT, YAG, capsulotomy or PRK ) are "optometric eye surgeons." Professionally that is the designation in our profession to differentiate the advanced skills. Not an ego trip at all so when patients ask if I am certified or not to perform the procedures, that differentiates between not having said certified skills. Does that make sense? A general dentist who doesn't have advanced oral facial maxillary skills wouldn't use the oral facial maxillary designation because they had not received advanced skills and doesn't do those surgeries. There's a closed facebook group "optometric eye surgeons on facebook" in which we share our clinical pearls, case studies to promote continuing improvement which of course sharpens our skills . We have a guest cardio guy from Rochester Medical today so need to get back to these power points. But, no to answer your question, no ego involved here that's simply the skills that I have acquired and what I am legally licensed to do.

For clarification, this is not quite accurate. First and foremost, it is Oral and Maxillofacial Surgeon (OMFS).

A general dentist cannot use the designation as an OMFS because it is illegal, it is as simple as that. That is comparable to an optometrist advertising him/herself as an ophthalmologist simply because there might be some overlap within their scopes of practice; it is misleading to the public. Lots of General Dentists can perform many of the same procedures as an OMFS, such as surgical implant placement, surgical extraction of teeth (depending on level of complication), conscious sedation, treatment of disorders associated with the Temporomandibular joint, treatment of various pathologies, management of trauma (again, depending on severity), etc. I CAN advertise that I perform particular procedures or particular treatment. The next time you see a sign for a general dentist, you will notice that they outline treatments, not training (extractions vs oral surgery, braces vs orthodontics, etc). This is because the public has the right to not be misled into thinking their GP has the same level of training as an OMFS. You will not see a general dentist harvesting bone, trying to reconnect a nerve that has been severed from some type of trauma, and the level of trauma a GP can manage is NO WHERE near the scope of that of an OMFS.

The GP's who have the more advanced skills do not have an additional designation. They are simply general dentists with a larger scope of practice. For example, I can do a Fellowship in dental implants that is recognized by the International Congress of Oral Implantologists (ICOI), but that does not mean I can legally call myself a Dental Implantologist - it is illegal and I would find myself in hot water very quickly.
You mentioned your residency at the University of Kentucky; a quick Google search shows that that program is a residency in Ocular Disease. To the public (who are the concern here), the term "optometric eye surgeon" implies an additional, surgical residency. Even with your additional training, that is not the case. Actually, I even Googled the term (because I am not informed when it comes to anything involving optometry or ophthalmology), and the term did not come up a single time. It does not seem to be a real title (anyone correct me if I am mistaken on this, again I am not informed on the topic). I am aware that our governing professional bodies all have different standards set, but public safety is a priority for any clinical profession. So my point is, I would be careful if I were you when it comes to titles and designation. It is quite possible that you too can find yourself in hot water if you use some sort of title that is not accurate.



Since I am on the topic of scope of treatment, when making the decision to pursue optometry, are there optometrists out there who expect to perform procedures generally performed by ophthalmologists? This is not an attack on anyone, I promise. Even if they are qualified to do them, why would they expect to? Again, because my familiarity is with dentistry I'll make my comparison there:
Dentists are providers that specialize in oral health. But if someone has a sore throat, they generally see their physician. Why is that? You'd think that dentists are more than capable of recognizing symptoms of a strep infection, doing a swab to test, and treating as necessary, right? I think they are, because it's more than just teeth. They have the education and training to diagnose and treat many of the pathologic conditions associated with the oral cavity, so a common strep infection is a piece of cake, right? Some might even argue they are even more qualified. But how often does this happen? In my experiences, it results in a referral to the patient's physician. But unless there is something I am unaware of, I do not see many dentists lobbying to address the right to treat this sort of infection. They are in the chair and being looked at by someone who can immediately diagnose and treat, yet they aren't. Even if it is best for the patient, it doesn't happen. Dentists don't go to school expecting to treat this sort of patient when they finish.

Now let's change this up - let's say the treatment of strep (or something similar that is within the scope of a dentists training and abilities, but usually not conducted by them) is a profitable cash reimbursement treatment. Do you think it would be a similar scenario?

Ok that was longer than I expected...sorry

 

[OD/ MD student]

For clarification, this is not quite accurate. First and foremost, it is Oral and Maxillofacial Surgeon (OMFS).

A general dentist cannot use the designation as an OMFS because it is illegal, it is as simple as that. That is comparable to an optometrist advertising him/herself as an ophthalmologist simply because there might be some overlap within their scopes of practice; it is misleading to the public. Lots of General Dentists can perform many of the same procedures as an OMFS, such as surgical implant placement, surgical extraction of teeth (depending on level of complication), conscious sedation, treatment of disorders associated with the Temporomandibular joint, treatment of various pathologies, management of trauma (again, depending on severity), etc. I CAN advertise that I perform particular procedures or particular treatment. The next time you see a sign for a general dentist, you will notice that they outline treatments, not training (extractions vs oral surgery, braces vs orthodontics, etc). This is because the public has the right to not be misled into thinking their GP has the same level of training as an OMFS. You will not see a general dentist harvesting bone, trying to reconnect a nerve that has been severed from some type of trauma, and the level of trauma a GP can manage is NO WHERE near the scope of that of an OMFS.

The GP's who have the more advanced skills do not have an additional designation. They are simply general dentists with a larger scope of practice. For example, I can do a Fellowship in dental implants that is recognized by the International Congress of Oral Implantologists (ICOI), but that does not mean I can legally call myself a Dental Implantologist - it is illegal and I would find myself in hot water very quickly.
You mentioned your residency at the University of Kentucky; a quick Google search shows that that program is a residency in Ocular Disease. To the public (who are the concern here), the term "optometric eye surgeon" implies an additional, surgical residency. Even with your additional training, that is not the case. Actually, I even Googled the term (because I am not informed when it comes to anything involving optometry or ophthalmology), and the term did not come up a single time. It does not seem to be a real title (anyone correct me if I am mistaken on this, again I am not informed on the topic). I am aware that our governing professional bodies all have different standards set, but public safety is a priority for any clinical profession. So my point is, I would be careful if I were you when it comes to titles and designation. It is quite possible that you too can find yourself in hot water if you use some sort of title that is not accurate.



Since I am on the topic of scope of treatment, when making the decision to pursue optometry, are there optometrists out there who expect to perform procedures generally performed by ophthalmologists? This is not an attack on anyone, I promise. Even if they are qualified to do them, why would they expect to? Again, because my familiarity is with dentistry I'll make my comparison there:
Dentists are providers that specialize in oral health. But if someone has a sore throat, they generally see their physician. Why is that? You'd think that dentists are more than capable of recognizing symptoms of a strep infection, doing a swab to test, and treating as necessary, right? I think they are, because it's more than just teeth. They have the education and training to diagnose and treat many of the pathologic conditions associated with the oral cavity, so a common strep infection is a piece of cake, right? Some might even argue they are even more qualified. But how often does this happen? In my experiences, it results in a referral to the patient's physician. But unless there is something I am unaware of, I do not see many dentists lobbying to address the right to treat this sort of infection. They are in the chair and being looked at by someone who can immediately diagnose and treat, yet they aren't. Even if it is best for the patient, it doesn't happen. Dentists don't go to school expecting to treat this sort of patient when they finish.

Now let's change this up - let's say the treatment of strep (or something similar that is within the scope of a dentists training and abilities, but usually not conducted by them) is a profitable cash reimbursement treatment. Do you think it would be a similar scenario?

Ok that was longer than I expected...sorry

To answer your question, yes, we go to optometry school to be a Doctor of Optometry school and the millenial generation especially fully expects for parity for same treatment for same services rendered. If we are taught, and we are taught, on how to use lasers, perform SLT, YAG capsulotomy and PI, and PRK then we fully expect to utilize that training. If we are taught to manage glaucoma, take the pharmacology classes to prescirbe oral and topical medications then we fully expect to utilize that training in every one of the 50 states. That is the feeling of the new graduates and certainly the view of someone my age.

 

[ophthope]

To answer your question, yes, we go to optometry school to be a Doctor of Optometry school and the millenial generation especially fully expects for parity for same treatment for same services rendered. If we are taught, and we are taught, on how to use lasers, perform SLT, YAG capsulotomy and PI, and PRK then we fully expect to utilize that training. If we are taught to manage glaucoma, take the pharmacology classes to prescirbe oral and topical medications then we fully expect to utilize that training in every one of the 50 states. That is the feeling of the new graduates and certainly the view of someone my age.

I just really don't understand your constant assertion of these things.

How in the world do you suppose that Optometry students, many of which are in States where it is not even legal for ODs to perform these procedures, are "trained" to do them? Do you actually think that simply studying and reading about surgery is sufficient to actually perform it without overall broad adequate surgical training? I mean we're not talking about someone well versed in DSAEK transitioning to DMEK here.

It is basically impossible to discuss these things with you since even basic words like "training" seem to completely differ in your vocabulary. An Ophthalmologist's training is broad and directed at comprehensive surgical and medical management of all eye diseases. There is a basic minimum number of surgeries in each subspecialty required to be performed and a larger amount of routine eye surgery such as cataract surgery that is required. There may be some sub-specialty surgeries which are not performed in their entirety your training but the overall set of surgical skills is so comprehensive that you can manage in those areas as well. For instance you might graduate without doing a full PKP - but you're going to have sutured a number of real, live, patient's corneas before you get out. Any procedures that most comprehensive Ophthalmologists do with regularity, you will have performed a number of times under supervision. So when a corneal laceration comes into the ER you are well equipped to handle it. You may not want to do it, but you were trained to do it. This also applies to laser procedures. That is what we mean by "training."

Could you please describe what training in SLT, YAG, LPI, and PRK an Optometry student in a State where ODs are not allowed to do laser procedures?


And I saw you "liked" my post above. Are you actually planning to graduate from the Caribbean, do an intern year, and attempt to perform ocular surgery without an Ophthalmology residency?

 

[schmoob]

To answer your question, yes, we go to optometry school to be a Doctor of Optometry school and the millenial generation especially fully expects for parity for same treatment for same services rendered. If we are taught, and we are taught, on how to use lasers, perform SLT, YAG capsulotomy and PI, and PRK then we fully expect to utilize that training. If we are taught to manage glaucoma, take the pharmacology classes to prescirbe oral and topical medications then we fully expect to utilize that training in every one of the 50 states. That is the feeling of the new graduates and certainly the view of someone my age.

It has nothing to do with age, or how grads feel; it's about what's legal and ethical.
Also, I've been on the other side of that laser, mine was done by an ophthalmologist. If given the choice to do it again, I would choose an ophthalmologist again. The additional years of training are in place for a reason, it is a surgical residency. If I found an "optometric eye surgeon," I would naturally think that they have similar training because I don't know any better. I would be quite upset if I found out I was misled and allowed someone to fire a laser inside my eye, by someone who received "training" that does not even begin to compare to what is the industry standard. I smelled my own eye dude, that's not something to toy with.
Tell me, why do you think 3rd molar extractions are usually done by an OMFS instead of general dentists, despite them being trained how to do it? Additional training serves a purpose.

 

[Trefoil]

For someone who wants to become an ophthalmologist, you don't seem to have much respect for many people in the field.

I don't foresee a bridge program starting because there really isn't a need for a large influx of new providers. I actually think ophthalmology is ahead of the curve in terms of addressing patient access issues--teleophthalmology, deep learning algorithms, etc--when compared to other specialties.

I would be interested to know how the bridge program for OMFS started, if anyone knows.

OMFS is really a unique field with procedures that other medical providers cannot do or provide. ENTs do not work on teeth. I remember getting scolded by an ENT while working on a fractured jaw. He was placed a plate, and he mentioned having to refer out for a fractured tooth. This kids gum line was cut open, and it never occurred to me that the ENT could have such a knowledge of the jaw without knowing anything about the teeth, but retrospectively it makes perfect sense. That being said, I would support a bridge program. I think that generally bridge programs attract the best and the brightest. If all of the best, and brightest optometrists need to go through residency and medical education to increase their scope of practice, they will likely become the leaders of optometry. They obviously wouldn't want other optometrists attempting the same practice with less training. Psychologically it makes our professions more equal, and it provides a link between them. Makes perfect sense to me.

 

[Trefoil]

My bad, your username has "Medical Student" under it. Might want to change that. Though I am genuinely curious why you spent a week at a walk-in clinic if you're not a student - not trying to be snarky, honestly just curious.

See that guy in your example was doing something criminal. Plenty of MDs do that too. I want you to find an OD who isn't obviously breaking the law for his own financial benefit, is just trying to be a good doctor, and still causes something major problems. Perhaps I wasn't clear, so that's my fault. Trouble is, training has nothing to do with that. Its entirely a matter of criminal versus not. MDs have much more training in this, and yet not a month goes by without an MD pill-mill getting shut down.

I guess I just don't see ODs as being unqualified to be able to prescribe narcotics. There are way WAY more dangerous drugs out there that aren't controlled that I'd rather they not prescribe. I would be much more concerned about an OD (or an ophthalmologist, if I'm being honest) prescribing metformin than I am a few percocet. If you're truly worried about this an no other drugs, do what my state did and have a quantity limit.

Maybe its just that I'm not worried about it. I'm a family doctor and if the NPs and PAs want to be able to write for schedule 2 drug, I don't really care. They aren't the problem with all of this, we are.

Metformin is generally a safe and well-tolerated medication with no addiction potential. We receive a general intern year and are generally supposed to be comfortable with managing primary care type medications. There really would be no point; however, since all of our diabetic patients are referred to us from a primary care provider (for the most part). Narcotics are a very different ball game. Outside of a fractured orbit or ruptured globe, I don't think most ophthalmologists would even consider prescribing natcotics. I believe that is the issue. Why grant the ability to prescribe something that is very addictive if it is outside of your scope of practice? I had bilateral corneal abrasions as a child, and I slept on a couch with my eyes closed for 48 hours. I wasn't given anything, and I was like 11 years old. I will admit it was terrible, but narcotics wouldn't really have helped much, and probably would have made me disoriented on top of everything.

 

[schmoob]

Metformin is generally a safe and well-tolerated medication with no addiction potential. We receive a general intern year and are generally supposed to be comfortable with managing primary care type medications. There really would be no point; however, since all of our diabetic patients are referred to us from a primary care provider (for the most part). Narcotics are a very different ball game. Outside of a fractured orbit or ruptured globe, I don't think most ophthalmologists would even consider prescribing natcotics. I believe that is the issue. Why grant the ability to prescribe something that is very addictive if it is outside of your scope of practice? I had bilateral corneal abrasions as a child, and I slept on a couch with my eyes closed for 48 hours. I wasn't given anything, and I was like 11 years old. I will admit it was terrible, but narcotics wouldn't really have helped much, and probably would have made me disoriented on top of everything.

I disagree. The narcotics would have helped very much. Opioids do serve a purpose. If taken therapeutically (and I understand this is the tough part for many), I don't believe there is anything wrong with prescribing them for an appropriate situation. I understand side effects exist, but good judgement (I also understand this isn't always a given) should be used if the situation calls for it. They exist for a reason.
I had PRK a number of years ago, and I was in alot of pain for the first 48. I was given a script for a few painkillers to help and thank goodness. I think I only took maybe half of them, but it was miserable. I would've been very frustrated if I had to endure more pain because of the actions of others, which had nothing to do with how I was feeling. I understand that I wouldn't have died if I hadn't taken them, but I used them in a manner that was responsible and medically ethical. So why not prescribe them if the patient has no history of substance abuse and they are in pain? Why should they be in pain?
Btw I'm not trying to call you out - I promise. I'm just trying to get different points of view on the matter.

 

[DrZeke]

I think the point StupidRoo is trying to make is that just because you can prescribe something doesn't mean you should and knowing your limitations is very important.
He mentions metformin, because although we all trained in an intern year we get farther and farther away from directly treating systemic conditions like diabetes and trying to adjust diabetic medications may be outside of our scope of practice. I can still prescribe insulin if I wanted to, but i chose not to as I accept my limitations and know that if I did try and adjust my patients diabetic medications it would be a disservice to them. I can't truly follow their progress or laBs and would ultimately be delivering subpar care. Similarly, I would not start any biologic agent on a patient before my uveitis fellowship and there are still people who treat uveitis and use the help of a rheumatologist to follow laBs and side effects. Narcotics for PRK is reasonable, but these things are a slippery slope with mid level providers. And yes - I will call an optometrist a mid level provider AKA can take care of eye problems within reason and with limits.

I recently encountered a patient with scleritis being treated by an optometrist for MONTHS with oral prednisone. No rheumatologist or any other physician was involved with this patient's care. Interestingly enough the patient had a history of hydradenitis suppurativa and was admitted to the hospital for an infection and active lesion. Turns out the patient had been on moderate to high dose oral steroids for months with an active tissue infection and no rheumatologic workup for her scleritis. Apparently >10mg /day of PO pred is A-ok. Or maybe it's not and optometrists don't actually learn enough about systemic disease and a systems based approach to a patient to be able to be prescribing such potent medications with significant side effects.

Our oath is do no harm. And maybe some of us forget that, but most of us don't. Optometrists take the optometric oath which begins with:

"With full deliberation I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously, and to the fullest scope of my competence. I will uphold and honorably promote by example and action the highest standards, ethics and ideals of my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted me."

Apparently some people overestimate their competence....




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[Bronze Medal]

It's a Dr. Jekyll and Mr. Hyde profession undoubtedly and ophthalmology has done nothing AT ALL to change these audacious behaviors. When ophthalmology gains a moral compass and moral fortitude then maybe my opinion will change. I highly doubt that will happen any time soon.

You are wrong to make such a blanket statement about ophthalmology. Sure, there are bad apples. The same can be said for every single profession, medical or non-medical. In my experience the vast majority of ophthalmologists are intelligent, hard-working, compassionate, respectful, and honest. We care about our patients. For you to state otherwise reveals your personal bias and poor insight into the ophthalmology community.

 

[calvnandhobbs68]

Yup the fundus photos are "HD Retinal Imaging" and FDT fields are "brain tumor tests." Cash only, of course.

My other favorite thing is that glaucoma suspects come in q2-3 months for exams. I just had a patient today who I inherited from an optom in another state. C/D 0.6, 89 years old with pre-treatment IOP of 16. The treatment plan (which had been going on for years):

"f/u 2 months HVF
f/u 4 months OCT
f/u 6 months Photos
f/u 8 months glasses/comp" ... repeat repeat repeat

In all of the years of this testing had never been a documented HVF defect or thinning anywhere on OCT.

Oh yeah love that ****.
Had that happen at the first optometrist I went to when I moved for residency. Of course they don't tell you about it when you call to make the appointment. I walk in and the secretary hands me a form to sign that says I know I'll have to pay $35 for "HD retinal imaging". I said hey how about he does the dilated fundoscopic exam that, you know, people usually do if he wants to take a good look at my retina. She goes "hmm I don't know he usually doesn't like to do those". That (along with another issue I had when I walked in) made me tell them to cancel my appointment right there and walked out. Straight money grubbing.

 

[VA Hopeful Dr]

Metformin is generally a safe and well-tolerated medication with no addiction potential. We receive a general intern year and are generally supposed to be comfortable with managing primary care type medications. There really would be no point; however, since all of our diabetic patients are referred to us from a primary care provider (for the most part). Narcotics are a very different ball game. Outside of a fractured orbit or ruptured globe, I don't think most ophthalmologists would even consider prescribing natcotics. I believe that is the issue. Why grant the ability to prescribe something that is very addictive if it is outside of your scope of practice? I had bilateral corneal abrasions as a child, and I slept on a couch with my eyes closed for 48 hours. I wasn't given anything, and I was like 11 years old. I will admit it was terrible, but narcotics wouldn't really have helped much, and probably would have made me disoriented on top of everything.

Hydrocodone is generally a safe and well-tolerated medication with very small addiction potential if used appropriately. And you're right, most ophthalmologists that I've met rarely write for it but every so often something comes up when you want to be able to do so.

I'm also about 99% sure that narcotics would have helped when you were 11.

 

[OD/ MD student]

I think the point StupidRoo is trying to make is that just because you can prescribe something doesn't mean you should and knowing your limitations is very important.
He mentions metformin, because although we all trained in an intern year we get farther and farther away from directly treating systemic conditions like diabetes and trying to adjust diabetic medications may be outside of our scope of practice. I can still prescribe insulin if I wanted to, but i chose not to as I accept my limitations and know that if I did try and adjust my patients diabetic medications it would be a disservice to them. I can't truly follow their progress or laBs and would ultimately be delivering subpar care. Similarly, I would not start any biologic agent on a patient before my uveitis fellowship and there are still people who treat uveitis and use the help of a rheumatologist to follow laBs and side effects. Narcotics for PRK is reasonable, but these things are a slippery slope with mid level providers. And yes - I will call an optometrist a mid level provider AKA can take care of eye problems within reason and with limits.

I recently encountered a patient with scleritis being treated by an optometrist for MONTHS with oral prednisone. No rheumatologist or any other physician was involved with this patient's care. Interestingly enough the patient had a history of hydradenitis suppurativa and was admitted to the hospital for an infection and active lesion. Turns out the patient had been on moderate to high dose oral steroids for months with an active tissue infection and no rheumatologic workup for her scleritis. Apparently >10mg /day of PO pred is A-ok. Or maybe it's not and optometrists don't actually learn enough about systemic disease and a systems based approach to a patient to be able to be prescribing such potent medications with significant side effects.

Our oath is do no harm. And maybe some of us forget that, but most of us don't. Optometrists take the optometric oath which begins with:

"With full deliberation I freely and solemnly pledge that: I will practice the art and science of optometry faithfully and conscientiously, and to the fullest scope of my competence. I will uphold and honorably promote by example and action the highest standards, ethics and ideals of my chosen profession and the honor of the degree, Doctor of Optometry, which has been granted me."

Apparently some people overestimate their competence....




Sent from my iPhone using SDN mobile

Or rather some people like you greatly underestimate our competence

 

[OD/ MD student]

It has nothing to do with age, or how grads feel; it's about what's legal and ethical.
Also, I've been on the other side of that laser, mine was done by an ophthalmologist. If given the choice to do it again, I would choose an ophthalmologist again. The additional years of training are in place for a reason, it is a surgical residency. If I found an "optometric eye surgeon," I would naturally think that they have similar training because I don't know any better. I would be quite upset if I found out I was misled and allowed someone to fire a laser inside my eye, by someone who received "training" that does not even begin to compare to what is the industry standard. I smelled my own eye dude, that's not something to toy with.
Tell me, why do you think 3rd molar extractions are usually done by an OMFS instead of general dentists, despite them being trained how to do it? Additional training serves a purpose.

"Dude", we are trained by other ophthapmologists in our laser training course, and our proctored laser eye surgery cases are directly under ophthalmology supervision. Over mt shoulder on everyone of my proctored laser cases was a great opthalmologist. Unless asked to name who my proctor was i wont "drop names" but that ophthalmology proctoring by your "uncle Toms" is how we maintain our quality control in our training. And yes, that meant i had alot of trips to Oklahoma to get those proctored cases under my belt, just like an ophthalmology resident

 

[Dr.Acula1]

Your assumption that taking pharmacology classes gives you the right to do as you wish with medications is wrong. Nurses take pharmacology courses as well, and yet they don't prescribe them. Even pre-meds take pharmacology courses....... Should Ophthalmologists be allowed to manage Ob-gyn issues just because they did a rotation during clerkship year? No. The training is long for a reason.

 

[MstaKing10]

"Dude", we are trained by other ophthapmologists in our laser training course, and our proctored laser eye surgery cases are directly under ophthalmology supervision. Over mt shoulder on everyone of my proctored laser cases was a great opthalmologist. Unless asked to name who my proctor was i wont "drop names" but that ophthalmology proctoring by your "uncle Toms" is how we maintain our quality control in our training. And yes, that meant i had alot of trips to Oklahoma to get those proctored cases under my belt, just like an ophthalmology resident

Just like an ophthalmology resident??? You really have absolutely no clue what you're talking about. None

 

[schmoob]

"Dude", we are trained by other ophthapmologists in our laser training course, and our proctored laser eye surgery cases are directly under ophthalmology supervision. Over mt shoulder on everyone of my proctored laser cases was a great opthalmologist. Unless asked to name who my proctor was i wont "drop names" but that ophthalmology proctoring by your "uncle Toms" is how we maintain our quality control in our training. And yes, that meant i had alot of trips to Oklahoma to get those proctored cases under my belt, just like an ophthalmology resident

Ok, using your logic - a physician can graduate medical school, do an internship year, go to Oklahoma or whatever for a few CE courses to get your training, and start firing lasers into patients eyes despite completely bypassing an ophthalmology residency?
I agree with Dr. Avila. Your logic would support an argument that the entire pharmacy profession as well as their required training is completely superfluous, since physicians receive training in pharmacology.
You can continue to present your argument, but you will not convince me, nor the majority of folks in here.
And I also encourage you not to represent yourself as an optometric eye surgeon to the public. It is not a recognized title, and you put yourself at risk of license sanctions and lawsuits from patients.

 

[awftho]

OD/MD: what are you going to do if you don't match into Ophtho? Something I would advise anyone applying to Ophtho to think about, and even more so as an foreign medical school grad.

 

[OD/ MD student]

Ok, using your logic - a physician can graduate medical school, do an internship year, go to Oklahoma or whatever for a few CE courses to get your training, and start firing lasers into patients eyes despite completely bypassing an ophthalmology residency?
I agree with Dr. Avila. Your logic would support an argument that the entire pharmacy profession as well as their required training is completely superfluous, since physicians receive training in pharmacology.
You can continue to present your argument, but you will not convince me, nor the majority of folks in here.
And I also encourage you not to represent yourself as an optometric eye surgeon to the public. It is not a recognized title, and you put yourself at risk of license sanctions and lawsuits from patients.

Whom actually decides if a title is recognizable or not? There is a closed group on Facebook alled "optometric eye surgeons on Facebook ".. shall i ask the group of 200 plus optometric eye surgeons to disband and take down all references to that term for you??

 

[DrZeke]

Or rather some people like you greatly underestimate our competence

I think many optometrists are competent, but there are a few bad apples who think that optometry = Ophthalmology. I worry about those with hubris who don't know when to ask for help or when it's time to hand off the patient. Clearly, you're one of those people.


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[long]

Whom actually decides if a title is recognizable or not? There is a closed group on Facebook alled "optometric eye surgeons on Facebook ".. shall i ask the group of 200 plus optometric eye surgeons to disband and take down all references to that term for you??

I'm not sure the presence of a Facebook group is the test of whether something is legitimate or not. Also, you used "whom" incorrectly.


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[DrZeke]

OD/MD: what are you going to do if you don't match into Ophtho? Something I would advise anyone applying to Ophtho to think about, and even more so as an foreign medical school grad.

Especially AUA. It does not have a track record of matching students to competitive residencies. Your best bet would have been St. Georges. And even that is a crazy stretch. Hope one of your "best buds" that you name dropped earlier will agree to take you on as pre-residency research fellow. Also, better get a 265+ on step 1.

 

[EyeDR_oo]

"Dude", we are trained by other ophthapmologists in our laser training course, and our proctored laser eye surgery cases are directly under ophthalmology supervision. Over mt shoulder on everyone of my proctored laser cases was a great opthalmologist. t

By definition and because of your training you sir are very dangerous.

Honestly it is nothing personal. When I was a first year general surgery resident, I had 250 cases as primary under my belt. Felt I could take on the world....until second year hit...and then third. It wasn't so much the year levels, as it was discrete time points in my training that made me realize just how unaware I was of my surroundings, abilities, and just how dangerous I had become in the process. That is why residency exists: The path off of the mountain with Sherpas who have done this trek 40+ years.... I'm sure you transcended though, or alleviated inquietude via facebook.

 

[snation]

OD/MS1 is very selective on what message he responds to

 

[schmoob]

Whom actually decides if a title is recognizable or not? There is a closed group on Facebook alled "optometric eye surgeons on Facebook ".. shall i ask the group of 200 plus optometric eye surgeons to disband and take down all references to that term for you??

I am not an optometrist nor an ophthalmologist. I'm not a physician either. So it pains me to do this...

American Optometric Association
Standards of Professional Conduct

"Advertising: Advertising by optometrists should be truthful and in accordance with prevailing federal and state laws and regulations. Optometrists who advertise should identify their professional degree and/or their profession in all forms of advertising and should never mislead the public regarding their expertise or competency. Optometrists should not hold themselves as having superior knowledge or credentials other than their earned degrees, certifications or license types."

Finding this took me a whole two minutes. First, I lead you in the right direction to look it up on your own, twice. My goal was not to embarrass you, but there comes a point when I can no longer protect you from embarrassing yourself. I am pointing things out to keep you from having issues with your licensure.
What your FB friends are doing do not concern you. Your advanced training is great and all, but you are NOT a surgeon. You are WILLFULLY disregarding your professions' own Code of Conduct.

 

[DrZeke]

I am not an optometrist nor an ophthalmologist. I'm not a physician either. So it pains me to do this...

American Optometric Association
Standards of Professional Conduct

"Advertising: Advertising by optometrists should be truthful and in accordance with prevailing federal and state laws and regulations. Optometrists who advertise should identify their professional degree and/or their profession in all forms of advertising and should never mislead the public regarding their expertise or competency. Optometrists should not hold themselves as having superior knowledge or credentials other than their earned degrees, certifications or license types."

Finding this took me a whole two minutes. First, I lead you in the right direction to look it up on your own, twice. My goal was not to embarrass you, but there comes a point when I can no longer protect you from embarrassing yourself. I am pointing things out to keep you from having issues with your licensure.
What your FB friends are doing do not concern you. Your advanced training is great and all, but you are NOT a surgeon. You are WILLFULLY disregarding your professions' own Code of Conduct.

THANK YOU.


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[OD/ MD student]

I am not an optometrist nor an ophthalmologist. I'm not a physician either. So it pains me to do this...

American Optometric Association
Standards of Professional Conduct

"Advertising: Advertising by optometrists should be truthful and in accordance with prevailing federal and state laws and regulations. Optometrists who advertise should identify their professional degree and/or their profession in all forms of advertising and should never mislead the public regarding their expertise or competency. Optometrists should not hold themselves as having superior knowledge or credentials other than their earned degrees, certifications or license types."

Finding this took me a whole two minutes. First, I lead you in the right direction to look it up on your own, twice. My goal was not to embarrass you, but there comes a point when I can no longer protect you from embarrassing yourself. I am pointing things out to keep you from having issues with your licensure.
What your FB friends are doing do not concern you. Your advanced training is great and all, but you are NOT a surgeon. You are WILLFULLY disregarding your professions' own Code of Conduct.

 

[OD/ MD student]

Its not superior. I am certified to perform the prk , slt, yag pi and yag capsulotomy surgeries. I am a Doctor of Optometry who performs those procedures. I always let my payients know my degree as well as the surgeries I am authorized to perform as an optometric eye surgeon. After this passes in Florida the optometrists who have this surgical training must be able to differentiate themselves from those that do not. How would you propose we hold ourselves out to differentiate those with vs. those without the training. I am receptive to your suggestions. Thank you though for your input.

 

[snation]

Its not superior. I am certified to perform the prk , slt, yag pi and yag capsulotomy surgeries. I am a Doctor of Optometry who performs those procedures. I always let my payients know my degree as well as the surgeries I am authorized to perform as an optometric eye surgeon. After this passes in Florida the optometrists who have this surgical training must be able to differentiate themselves from those that do not. How would you propose we hold ourselves out to differentiate those with vs. those without the training. I am receptive to your suggestions. Thank you though for your input.

There is no such thing as an optometric eye surgeon. You are not a surgeon. Period.

 

[OD/ MD student]

There is no such thing as an optometric eye surgeon. You are not a surgeon. Period.

Well that's your perogative. But, over the summer I'm doing surgery on several of my med school classmates who want PRK laser eye surgery. Shall I drop the "surgery" part and simply call it PRK to make you feel better my friend and colleague?

 

[snation]

Well that's your perogative. But, over the summer I'm doing surgery on several of my med school classmates who want PRK laser eye surgery. Shall I drop the "surgery" part and simply call it PRK to make you feel better my friend and colleague?

You can call it whatever you want man, still doesn't change reality.

 

[OD/ MD student]

Again, this is not a pride or ego issue. The most humble Ophthalmologists I know are not in support of bills such as these.

And you posted a comment on that article using your public facebook account. You may wish to remove that. You continue to over-expose yourself and your colleagues who you reference by name. It is your choice to have a public online identity but your acquaintances may not wish to be referenced so often.

I also disagree with your comment on that news article that these procedures are "mind numbingly easy to perform" and "a push of a button." Those are your words, and to mislead the public to believe that a procedure such as refractive surgery is simple is far more manipulative than insinuating that re-op rates are higher for ODs than MDs. If you actually have done PRK I hope you realize that holding down the button on the excimer is not the difficult part of that surgery.

Yes, sir. I have "actually done" my PRK cases under direct proctor ophthalmology supervision, just like I'm sure you have done as well. All healed within a quarter to half of the target goal without complications. Had an excellent ophthalmologist as my mentor who did a great job over my shoulder as I performed PRK laser eye surgery. If you'd like to sit in as a proctor for the next group of 25 PRK optometric eye surgeons (the name of the class) I'm sure your expertise would be appreciated. I'm to busy too help with the next group . Hope your day is great.

 

[doctalaughs]

Yes, sir. I have "actually done" my PRK cases under direct proctor ophthalmology supervision, just like I'm sure you have done as well. All healed within a quarter to half of the target goal without complications. Had an excellent ophthalmologist as my mentor who did a great job over my shoulder as I performed PRK laser eye surgery. If you'd like to sit in as a proctor for the next group of 25 PRK optometric eye surgeons (the name of the class) I'm sure your expertise would be appreciated. I'm to busy to help with the next group . Hope your day is great.

So whats your motivation for getting the MD? Seems you haven't answered that question despite being asked multiple time.

I'm not in the field so no horse in the game but being a physician I see the same old tired arguments across so many disciplines (crna vs anesthesiologist, pa/np vs physician etc)


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[tongtongbravo]

Guys, let's not get the focus blurred by this OD/MD person. Before you take time to argue/reply to this person, please take 5 minutes to write to the senator. It's very annoying that this 'bill' came even this far.

There is a reason why we go through 8 years of rigorous training including the medical school. Certain eye conditions sometimes require recall the information we studied during first 2 years of medical school and some random disease we see during 3/4th year rotations. It's just dangerous for optometrist trying to do more invasive stuff without proper training/knowledge period. Trust me, I bet even junior high school kid can do cataract surgery if they do 500+ cataracts, but that's not the point. "Eyes dont see what your mind doesnt know" And guess what? it is that 1 case of 100 that will go wrong and, you are really screwing up the patient's life(and no ophthalmologist is going to take that patient). Ophthalmologists are trained medical/internal medicine(with all 3 USMLE ) doctors before they are specialized to become eye doctors. So the scope of knowledge is very different from non-M.D. personnel. And in reality, not everyone can become medical doctors. So sometimes, just admit the fact that you got outcompeted by better test-taker (or whatever you call it). I am trying to say, do not look for the shortcut because it will comeback and haunt you one day.

But again, please take few minutes to write and let's show senators that it is for the best interest of the patients.

 

[schmoob]

Its not superior. I am certified to perform the prk , slt, yag pi and yag capsulotomy surgeries. I am a Doctor of Optometry who performs those procedures. I always let my payients know my degree as well as the surgeries I am authorized to perform as an optometric eye surgeon. After this passes in Florida the optometrists who have this surgical training must be able to differentiate themselves from those that do not. How would you propose we hold ourselves out to differentiate those with vs. those without the training. I am receptive to your suggestions. Thank you though for your input.

My input on what you should call yourself does not matter. What you think you should call yourself does not matter. The only guidance you should be following is that of the American Optometric Association. Procedures you're allowed to perform in one state does not give you the autonomy to begin awarding yourself made up titles; if it is not a recognized specialty within the AOA you are not allowed to give yourself the title. You call yourself an Optometrist, because that is what is written on your degree. You have an NPI number, right? Check what it says next to Taxonomy. Whatever is in that block is the ONLY title you may hold.
So whatever it is you tell your patients about the procedures you are "certified" to perform using a misleading title (because it does not exist) is in fact, false. This is ANOTHER violation of the AOA Code of Conduct.

 

[ojoseco]

unfortunately the term "optometric physician" seems pretty well established and came about do to legislative and drug prescribing reasons from what I can gather.....I cannot find any info on the term "optometric surgeon" other than OD/MDs mention of the facebook group

Its pretty clear to me that both of these terms are extremely misleading to patients. If optoms are going to gain prescribing and surgical privelages, we at least need additional legislature to prevent them from using these misleading titles so patients are very clear about the fact that they did not attend medical school or residency. This is basic patient/consumer protection.


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[OD/ MD student]

My input on what you should call yourself does not matter. What you think you should call yourself does not matter. The only guidance you should be following is that of the American Optometric Association. Procedures you're allowed to perform in one state does not give you the autonomy to begin awarding yourself made up titles; if it is not a recognized specialty within the AOA you are not allowed to give yourself the title. You call yourself an Optometrist, because that is what is written on your degree. You have an NPI number, right? Check what it says next to Taxonomy. Whatever is in that block is the ONLY title you may hold.
So whatever it is you tell your patients about the procedures you are "certified" to perform using a misleading title (because it does not exist) is in fact, false. This is ANOTHER violation of the AOA Code of Conduct.

But, then again Medicare defines optometrists as physicians thus every optometrist in Florida using the term "optometric physician" legally , I might add, and without violating any ethical standards. I guess why don't you tell me what title you would like to give Doctor's of Optometry in Florida who perform laser eye surgery. There you go my friend, there's the respect I'm giving you by asking for your feedback.

 

[ojoseco]

Optometrists with certification in XYZ procedure---thats what you should call yourself

What is wrong with this term?

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[schmoob]

But, then again Medicare defines optometrists as physicians thus every optometrist in Florida using the term "optometric physician" legally , I might add, and without violating any ethical standards. I guess why don't you tell me what title you would like to give Doctor's of Optometry in Florida who perform laser eye surgery. There you go my friend, there's the respect I'm giving you by asking for your feedback.

Did you read any of my response? I did in fact give you the title you requested. And at what point did I even mention the title "optometric physician?" Do not put words in my mouth.
It's clear that you choose to continue along this path. If you wanted to show respect, I recommend respecting your Code of Ethics first. Good luck.

 

[long]

I don't care how established it may be, I still think the term optometric physician is ridiculous. As is optometric surgeon.


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[doctalaughs]

Ok i went and signed it -despite not being in the field MDs need to stick together against midlevel encroachment. What they dont understand is the LEAST competent person in their field needs to be able to perform similarly to a fully residency-trained physician if we are going to open it to a whole different class of healthcare providers. Otherwise there is a very clear path- go to medical school and complete a residency in the field you wish to practice in.


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[Slide]

My input on what you should call yourself does not matter. What you think you should call yourself does not matter. The only guidance you should be following is that of the American Optometric Association. Procedures you're allowed to perform in one state does not give you the autonomy to begin awarding yourself made up titles; if it is not a recognized specialty within the AOA you are not allowed to give yourself the title. You call yourself an Optometrist, because that is what is written on your degree. You have an NPI number, right? Check what it says next to Taxonomy. Whatever is in that block is the ONLY title you may hold.
So whatever it is you tell your patients about the procedures you are "certified" to perform using a misleading title (because it does not exist) is in fact, false. This is ANOTHER violation of the AOA Code of Conduct.

Based on his responses and some quick research into this guy, ethics is the last thing on this guy's mind. He's bankrupt and needs a way to fast track even more cash procedures to get out of bankruptcy. It's funny that he complaints bitterly about bad ophthalmologists but at the core this guy is no different from them.

I've stopped trying to debate with this guy; there'st
nothing you can say that will change his mind and any form of logic you present he will ignore or regurgitate talking points like a political hack. His ego is beyond belief despite being a Caribbean med student (ha, good luck matching bro). The real thing to get out of this is to fight back and write to these reps or donate to the surgical scope fund to protect our patients against these dangerous and deadly individuals.

 

[Slide]

Or rather some people like you greatly underestimate our competence

If anything you are just proving us right.

 

[VA Hopeful Dr]

My input on what you should call yourself does not matter. What you think you should call yourself does not matter. The only guidance you should be following is that of the American Optometric Association. Procedures you're allowed to perform in one state does not give you the autonomy to begin awarding yourself made up titles; if it is not a recognized specialty within the AOA you are not allowed to give yourself the title. You call yourself an Optometrist, because that is what is written on your degree. You have an NPI number, right? Check what it says next to Taxonomy. Whatever is in that block is the ONLY title you may hold.
So whatever it is you tell your patients about the procedures you are "certified" to perform using a misleading title (because it does not exist) is in fact, false. This is ANOTHER violation of the AOA Code of Conduct.

The AOA is just a trade group like the AAO for ophthalmologists. The state optometric boards actually get to define ethical conduct just like the state medical boards do for us.

 

[schmoob]

The AOA is just a trade group like the AAO for ophthalmologists. The state optometric boards actually get to define ethical conduct just like the state medical boards do for us.

Ethics and law are separate. State boards are responsible for the application of state law as they apply to clinical licensure. The AOA, AAO, ADA, etc do not have any legal authority.
There is lots of overlap between the ethics and law. Unethical conduct may not always be illegal, but many times it is. It comes down to interpretation of the law, which is why the state boards exist.

 

[VA Hopeful Dr]

Ethics and law are separate. State boards are responsible for the application of state law as they apply to clinical licensure. The AOA, AAO, ADA, etc do not have any legal authority.
There is lots of overlap between the ethics and law. Unethical conduct may not always be illegal, but many times it is. It comes down to interpretation of the law, which is why the state boards exist.

Incorrect, at least in my state. Both the medical board and the optometry board define professional ethics for the profession and consequences of breaking them.

The AOA, AMA, AAO, ADA, and so on have no authority at all over non-members, so their code of ethics is toothless.

 

[schmoob]

Incorrect, at least in my state. Both the medical board and the optometry board define professional ethics for the profession and consequences of breaking them.

The AOA, AMA, AAO, ADA, and so on have no authority at all over non-members, so their code of ethics is toothless.

Toothless I'll definitely keep an eye out for more puns
I am not disagreeing about authority, you are absolutely right. I think you are misunderstanding that Ethics =/= Law. States define and enforce law. Unethical behavior is often illegal, especially in health care; often enough that it would be easy to mistake them.
I started writing about the differences, but I found this definition and it explains it better:
" Ethics and law differ in that ethics are social guidelines based on moral principles and values while laws are rules and regulations that have specific penalties and consequences when violated. Ethics do not have punishments, fines or associated penalties when people fail to abide by them while laws do."

 

[MstaKing10]

Toothless I'll definitely keep an eye out for more puns
I am not disagreeing about authority, you are absolutely right. I think you are misunderstanding that Ethics =/= Law. States define and enforce law. Unethical behavior is often illegal, especially in health care; often enough that it would be easy to mistake them.
I started writing about the differences, but I found this definition and it explains it better:
" Ethics and law differ in that ethics are social guidelines based on moral principles and values while laws are rules and regulations that have specific penalties and consequences when violated. Ethics do not have punishments, fines or associated penalties when people fail to abide by them while laws do."

Apart from all that would be the standard of care argument that may be employed say in a malpractice case.