An introspective explanation about my optometry posts

[ProZackMI]

---

Members do not see this ad.

WARNING: Long-winded verbiage; do not read if you're pressed for time, have a life, or do not expect to live much longer.

I've been posting on SDN for about 3 years now, give or take, and in that time, I have had both civil and non-civil discussions about various professions. When I first started here, I was a vocal critic of my own profession, psychiatry. Having seen my specialty decline into the quagmire of known medical specialties, for various reasons, and realizing that I spent 4 years of medical school and 4 years of residency preparing myself for a lifetime of 15-20 minute medication reviews, I began posting on SDN as a way to vent and connect with other dissatisfied psychiatrists. Soon, I began to wander into other fora (psychology, pharm, opto, etc.) and found many other professionals in the same boat as me: looking for love in all the wrong places/unhappy with their career choices/looking for something else.

I honed in on the optometry forum for a few reasons. First, I noticed that more optos than pharms, psychologists, dentists, etc., were unhappy with their chosen profession and posting their frustration. Second, I had two patients who were deeply unhappy about their personal and professional lives; one was a chiropractor who eventually became a high school history teacher and the other, a former optometrist who now works as a PA. The optometrist, a middle-aged guy with two teenagers and a harpy of a wife, was so unhappy with his career, and so bored, he created an active fantasy life for himself and frequently posed an OMD surgeon. In fact, when his mother-in-law was hospitalized with nephrotic syndrome, he actually tried to tell the attending how to treat her and almost got himself in serious legal trouble. He frequently "played doctor". The genesis of his problem was profound regret at not getting into Wayne State for medical school like his brothers and father. He resented optometry, which was merely a fallback career for him, and coveted the life of a physician. Having worked with him for 3 years, I learned a great deal of his PERSONAL SUBJECTIVE view of your profession. When I came to SDN, I saw some of the same patterns in the OD forum.

Many of you on this forum seem to think I'm a rabid anti-Optometrite. Am I really? Am I a true critic of a profession I admittedly know very little about? No, I am not. Do I really give a rat's ass about what an OD does or does not do? No, I do not. I do not feel ODs are a threat to me personally or anyone in either of my professions. Optometry will never displace psychiatry or law, and in my opinion, it will never displace or replace ophthalmology.

My true problem is not with the professional optometrists who post on this board (except IndianaOD who seems to think he graduated from medical school). It is with the students and college students who have yet to enter the profession (e.g., oculomotor, gochi, and a plethora of others) who entered a profession for the wrong reasons: (1) doctoral title; (2) perceived status/prestige; (3) respect; (4) look cool in a white coat. These students seem to want a back-door entry into the practice of medicine. They seem to be under the impression, much like their chiropractic friends, that they are going to become physicians upon graduation from optometry school and will have a happy, prosperous career ahead of them. Will they? Graduation from any school does not guarantee happiness. Do you know how many MDs and DOs out there are unhappy in their careers? MANY!!!

I think optometry has many benefits over ANY branch of allopathic or osteopathic medicine. Whether you choose retail or clinical optometry, once you finish your education in 4 years, you are done! You do NOT have to undergo clinical rotations in areas where you wouldn't wish your worst enemy to work (e.g., OB-GYN, general surgery, geriatrics). You do NOT have to undergo internship or MANDATORY PGY residency training. In just four years of OD school, you actually learn how to do your job and do it well. On the MD side of the coin, medical school gives us a tiny portion of the knowledge we need to practice; it's the PGY training that teaches us how to actually do what we do and do it well!

If you guys want to do a residency, it's one year and highly focused: contact lenses, primary care, etc. You don't spend your nights on call. You don't have to insert your hands into someone's mouth, rectum, or vagina. You don't have to worry about blood, vomit, feces, or other bodily fluids. You don't have to watch people suffering and dying. Yes, even a lowly psychiatrist has done all of this. I also did a residency in IM. I saw a 14-year-old boy die in his mother's arms due to CLL. I've seen MVAs so bad, the victims were barely recognizable as human beings. I've seen patients of mine die from self-inflicted wounds in the ER.

An optometrist has a career and a life. A physician, in the US, does not; he/she has a life and it often becomes intertwined with career. You bring the gift of sight into people's lives. NO ONE is ever afraid to come see you. Even little kids don't fear ODs. No one enjoys going to the dentist. No one enjoys going to a doctor's office. Most people hate having to hire a lawyer. Seeing a shrink isn't usually the top of the list of "things I wanna do today" for most people. Getting a new pair of specs and seeing the friendly, kindly neighbourhood eye doctor is something that most people have no problem doing. No blood, no pain, minimal inconvenience. No waiting. No nasty tests. You rarely have to deliver horrible news to patients. How many ODs really get sued for malpractice? What is your malpractice cost? How many of you optometrists have to testify in court for PROFESSIONAL matters? How many of your patients call you up at 4:00 am after ODing on Xanax or SSRI de jour? How many of your patients sue you because their husband decided to impregnate his niece and blame you for it?

You guys have a great job when you think about it. Yes, it would be nice if your jobs were more "medical" and it would be nice if you could be more like doctors, but there is simply no need for ODs to fill that role or enter that niche. Why compare your profession to dentistry or podiatry? Why compare it to ophthalmology? There is a reason why optometry school grants the OD degree and not the MD or DDS or DPM or whatever degree. You are not dentists, nor are you like dentists. Dentistry and podiatry are actual offshoots of allopathic medicine. Optometry is not and never was; its roots are completely non-medical and evolved over the years.

My point is, be glad you are part of a unique and respectable profession. NO ONE hates optometrists. No one fears optometrists. No one dreads going to see the optometrist. No one dies in your care and your liability is minimal. You meet lots of people and provide a valuable service. No one except you and your mother will give a rat's ass that you are a "doctor". Butchers wear white coats too. Your degree and training may be quite advanced, and you may know a lot when you graduate, but in reality, you'll forget most of it once you begin doing whatever it is you will mostly do. Yes, you are trained. Yes, you know pharmacology and anatomy. No, you are not physicians. No, you are not surgeons. No, you are not LIKE dentists or podiatrists or pharmacists or any other profession. You are an optometrist. If you need to compare your profession to another, audiology is the closest there is to comparison. If, however, you compare and covet the trappings of other professions (e.g., dentistry and medicine), go to medical school or dental school. DO NOT enter optometry because you couldn't get into medical or dental school. DO NOT enter optometry because being called DOCTOR is cool. Enter optometry because you want to be an optometrist. How hard is that to understand?

Many of you, like qopty, KHE, hello07, and a few others, know your professional strengths and weaknesses, know your training, and are happy with your career choice. I see common sense and true professionalism in their postings. Others are delusional, disgruntled, and overly critical. If you are unhappy in your personal life, you will be unhappy in your professional life. If you are unhappy in your professional life, why? Ask yourself why and seriously attempt to answer the question. The next question should be, "what can I do to make my job/career better/more exciting?" Think about it. Sometimes the answer will surprise you. Sometimes it won't. If you find yourself unhappy, explore and weigh your options. Even if you are older, it's NEVER too late to change, evolve, or try something new. I'm 37. I went from doctor to lawyer once I asked myself that question, "what can I do to make my life better?" At that time, I was 30 and barely out of residency. If my lazy ass can do it, so can you. KHE left optometry to teach high school, if my memory serves. Ask him about change! If you're an OD and unhappy, what about academia? What about consulting? Go back and get an MBA and do optometric management! Get an MSW and be a social worker. There is so much you can do with your degree besides practice. You can teach at the college level, work for government agencies, work for insurance companies, go into management and consulting, etc. If you have a family and student loans, then your options are more limited, but still...do what you have to make life interesting before it becomes too late.

I wish someone had told me this back in 1992 when I entered medical school. I wish I had entered medical school for the right reasons. If you go through your professional life saying "what if" all the time, you'll never be happy. Avoid EPIC FAIL and do what you want to do in the first place.

 

[dukeopt]

Great post. I think you are right on in most of what you say; hopefully not with the part about me not having a life for reading this...

 

[KHE]

WARNING: Long-winded verbiage; do not read if you're pressed for time, have a life, or do not expect to live much longer.


.

I have to admit, I'm somewhat perplexed as to what the motivation for that posting was.

But in any event, I think that in general, students and prosepctive students oftem times have a distorted view of what the profession of optometry is, or what 99% of optometrists do on a daily basis.

I have a practice that is about as "medically and disease" oriented as an optometric practice can get. We have most of all of the fantastic and high tech gadget toys out there. We have good working relationships with local physicans and specialists. And I would say that only about 10% of my patients require me to deal with anything more serious than glasses, contacts, dry eye, or mild ocular surface irritation from contact lens overwear or seasonal allergies. And of those remaining 10%, the majority of those are relatively uncomplicated glaucoma patients and patients with no or little diabetic retinopathy.

For whatever reason, students often get the notion that they are going to be called on to manage all this complex ocular pathology and neurological cases on a day to day basis, and that simply doesn't happen for the majority of ODs out there.

I think that it is this disconnection that fosters the disillusionment.

 

[IndianaOD]

Zack,

Recently I think a lot of the blame falls on the AOA and the schools for many of the problems.

I like what I do overall, just don't like all the BS in the background. Nobody tells you about the problems with insurances, massive oversupply, opticians and ophthlamology stabbing you in the back etc.

The schools pretty much train you to be a non surgical OMD. I bet more than half the time is spent on eye disease, systemic disease, and physio-pharm. Do you not expect ODs to want to do what they were trained to do?

Who knows, maybe I should have gone into Dermatology (my second choice) since I had the grades and scores to do it. You are right though, I like spending time with the family. I don't like the MDs on here thinking they know everything. OMDs HAVE to know that I learned things in my 5 years that they didn't in their 3 years of surgical based residency.

 

[qwopty99]

WARNING:
I've been posting on SDN for about 3 years now, give or take, and in that time, I have had both civil and non-civil discussions about various professions.

Your assessment of the scope of optometry might be more narrow than what many forumites here would prefer it to be, but you've basically nailed it. Not bad for a non-OD.

 

[VA Hopeful Dr]

Zack,

Recently I think a lot of the blame falls on the AOA and the schools for many of the problems.

I like what I do overall, just don't like all the BS in the background. Nobody tells you about the problems with insurances, massive oversupply, opticians and ophthlamology stabbing you in the back etc.

The schools pretty much train you to be a non surgical OMD. I bet more than half the time is spent on eye disease, systemic disease, and physio-pharm. Do you not expect ODs to want to do what they were trained to do?

Who knows, maybe I should have gone into Dermatology (my second choice) since I had the grades and scores to do it. You are right though, I like spending time with the family. I don't like the MDs on here thinking they know everything. OMDs HAVE to know that I learned things in my 5 years that they didn't in their 3 years of surgical based residency.

Just two quick things - many of the folks that come in here (me included) are in training. As you know very well, things change outside academia. Most OMDs get much friendlier (if they like doing surgery, at least). Many times its just worth ignoring.

Likewise, anyone that knows jack about optometry (I tentatively put myself in that list) knows y'all are much better than MDs at almost everything vision (including CLs, VT, complex refractions). I would say equals at lots of medical stuff (knowledge/skill wise) but often times better because in my experience ODs spend more time examining every part than many MDs do. That's how you catch the really early/small things. Hell, this is why I go to ODs for everything sans surgery.

I make no comment about scope because, quite frankly, I don't know enough about much of what you say much less how hard it is or what the complications can be.

 

[qwopty99]

OMDs HAVE to know that I learned things in my 5 years that they didn't in their 3 years of surgical based residency.

If you're going to just count years as a determinant, then you have to concede that they learned things in their 7 (4+3) years of medschool/ophthalmology that you didn't in your 5 years of optometry.

 

[qwopty99]

Likewise, anyone that knows jack about optometry (I tentatively put myself in that list) knows y'all are much better than MDs at almost everything vision (including CLs, VT, complex refractions).

I'll just add the obvious, that you're speaking in generalizations, and there are certainly some ODs parked in the far away corner of some malls, who do nothing but spin dials.

 

[Oculomotor]

In all fairness ProZack had a good post.

I agree with Indiana OD as well most of the time and I did not go into optometry to become an ophthalmologist--seriously. The amount of eye disease treatment I will get to do ( I have a situation waiting for me when I am done) will be better then average so I have no problem doing refraction, glasses, and contacts 50-60% of the time (AOA suvey average is 65%). Nonetheless, I work my a s s off and I will make sure that I will be the best doctor of optometry I can be. There are a lot of passionate people on this forum who worked hard to earn their degrees---no one wants to feel diminished or disrespected for their work...

 

[qwopty99]

no one wants to feel diminished or disrespected for their work...

So this is what all your posts are about afterall.

 

[IndianaOD]

If you're going to just count years as a determinant, then you have to concede that they learned things in their 7 (4+3) years of medschool/ophthalmology that you didn't in your 5 years of optometry.


You'll never win this debate using the argument that you are more trained "in the eyes" than ophthalmologists are. I don't think too many people will grant you this point, regardless of your views. At best, the argument sounds hackneyed and contrived. Who do you refer your problems out to? Ophthalmologists. So how can they be less trained than you?


If you're going to argue anything, argue that you are clearly superior to non-OMD-MDs in the eyes, and why is it they can do more procedures than you?

Sure they learn a bunch of non-eye stuff that will never be used. Of course they know more about surgery because that's what they spend most all of their time on. I think if you are talking about "vision" I don't think there is much of an argument for the OMD side.

What is your point?

There is just NO way an OMD knows everything a decent OD does and same the other way. Sorry you have a problem with this fact.

 

[blysssful]

As someone applying for optometry school right now, this was, to say the least, interesting to read. By no means was I under the impression that all ODs were happy with their decisions, however it is rather unnerving to read that MORE ODs are unhappy with their decisions by comparison to other health care professions. However, it does not surprise me in the least that someone who entered the profession because they couldn't get into their first choice would be unhappy... doesn't this seem like a pretty obvious result? I think most people that have to "settle" for second best, whatever the topic, will end up resenting it. It's like if you really like a chick but she's not into you, so you date her fat sister instead. Obviously, it's not going to be as satisfying.

Honestly, I am very excited about my future with optometry. I suppose I also don't have a traditional post-graduation plan, as I want to practice overseas (specifically with Unite for Sight)...so I guess I'm not as worried about the over-saturation of the market or insurance companies at the moment.

The truth is that most people (MDs and dentists included) would be lost without their sight, and people who specialize in vision are irreplaceable. They are not MORE irreplaceable than MDs, because well, you can't see if you're dead... but my point is that I don't think there needs to be a competition as to "who is more valuable" or "who knows more". There are reasons why people specialize in certain fields--so that we can work together towards a common goal.

(Sorry if this post is a little...random. I'm kind of out of it at the moment.)

 

[xmattODx]

Honestly, I am very excited about my future with optometry. I suppose I also don't have a traditional post-graduation plan, as I want to practice overseas (specifically with Unite for Sight)...so I guess I'm not as worried about the over-saturation of the market or insurance companies at the moment.

Perhaps you can expand on the above paragraph in a new thread. I'm not clear how one can "practice overseas" nor was I aware that Unite for Sight had any salaried positions. I, too, entered optometry with the thought that much of my time would be spent in developing countries. I'm still trying to figure out how to make this happen.

 

[blysssful]

Perhaps you can expand on the above paragraph in a new thread. I'm not clear how one can "practice overseas" nor was I aware that Unite for Sight had any salaried positions. I, too, entered optometry with the thought that much of my time would be spent in developing countries. I'm still trying to figure out how to make this happen.

No, you're right. Unite for Sight is non-profit. I didn't mean that I was going to post up a practice in the middle of the Sahara. 🙂

 

[xmattODx]

No, you're right. Unite for Sight is non-profit. I didn't mean that I was going to post up a practice in the middle of the Sahara. 🙂

I ask because many optometrists are keen on making change in the world but with optometry being non-existent in most countries it is difficult to "practice" and see patients.

More likely an optometrist who wants to work in developing countries will be teaching or doing public health type work (although some are able to create and staff clinics - a topic for another day). Being in a developing country also requires accepting a much lower salary than can be obtained in the US or Canada.

These realities make paying back exorbitant student loans while working overseas very difficult and in turn often require part-time work in the US coupled with overseas work. Your comment:

so I guess I'm not as worried about the over-saturation of the market or insurance companies at the moment

worries me. The abundance of ODs and falling reimbursement do affect one's ability to work overseas.

I applaud your desire and hope that you're able to do what you want but keep your debt down and consider adding a public health degree to your plans. Good luck! When you unlock the secret of how to predominantly do work in developing countries let me know!

 

[ProZackMI]

Zack,

Recently I think a lot of the blame falls on the AOA and the schools for many of the problems.

I like what I do overall, just don't like all the BS in the background. Nobody tells you about the problems with insurances, massive oversupply, opticians and ophthlamology stabbing you in the back etc.

The schools pretty much train you to be a non surgical OMD. I bet more than half the time is spent on eye disease, systemic disease, and physio-pharm. Do you not expect ODs to want to do what they were trained to do?

Who knows, maybe I should have gone into Dermatology (my second choice) since I had the grades and scores to do it. You are right though, I like spending time with the family. I don't like the MDs on here thinking they know everything. OMDs HAVE to know that I learned things in my 5 years that they didn't in their 3 years of surgical based residency.

A few points:

1) How does the average OD have 5 years of optical training? Let's be honest here, you have FOUR years of optometry school. Of those 4 years, taking the basic science (anatomy, physio, pathophys, pharm) out of the picture, how many actual YEARS of visual training do you have? 2 or 3? Using your math, you have 5 years. Four years of optometry school + what?

Don't even try to sell that residency bunk here. How many OD's actually do a residency? Also, your residency is VOLUNTARY; it's not required.

So, based on the real numbers, here, you're still better trained in ocular disease and management than non-surg OMDs, who have 3-4 years of specialized residency + internship and rotation + whatever they learned in medical school?

Even with a residency, your OD only has, at best, 3-4 years of actual training in eye disease and management, whereas the OMD has 5+ (1 year med school + whatever rotations/internship exposure to eye disease/mgt + 4 residency).

Nice try.

 

[qwopty99]

There is just NO way an OMD knows everything a decent OD does and same the other way. Sorry you have a problem with this fact.

I did not suggest this. And I don't have a problem with this.

 

[qwopty99]

It's like if you really like a chick but she's not into you, so you date her fat sister instead.

Oh gawd, I hope optometry is not that bad.

 

[ProZackMI]

I did not suggest this. And I don't have a problem with this. You also don't have to be so stand-offish.



Further, as an aside, your list of "facts" are usually "facts according to Indiana". There are some things called opinions, and other things called facts. You really should learn to delineate the two. You are apt to confuse the two, whenever issues regarding your education come up, which is most of the time since you're always talking about it.



Keep in mind that you do have a longer leash here than the average forumite due to your training, and for that I think many of us have tolerated your "I am greater than thou" attitude. But it does wear thin. Your arguments are always based on how you're more educated than OMDs. Perhaps you should look in the mirror and realize it comes across as very arrogant and ignorant. Not too many people will buy it, no matter how many times you say 5 > 3.



I know all about your GPA, that you could've matched dermatology, that you have the same ability in anatomy and pharmacology as MDs, and that you have superlative training in the eyes, but that doesn't make you an ophthalmologist and you don't have the training of one either.



This post isn't intended to treat your education as "glass-half-empty", but you've never been particularly fair in making comparisons. If you want people to respect your education, you have to first respect theirs.

How could someone who never attended medical school know he "coulda" matched into a derm residency? HUH? Ummm, when I graduated medical school, in order to even find out if you matched into a residency, you know, you had to um....ATTEND medical school, then GRADUATE medical school, then COMPLETE a one year rotating internship, then successfully pass the USMLE I-II BEFORE you applied for a residency program.

How would an optometrist know he'd match into ANY allo/osteo residency program? I don't get it! Am I missing something here?

Also, sincerely, no disrespect intended, but like...no way does an OD have more medical training than ANY physician, psychiatrist included. No way, no how. NO OD program would provide a student with more hours of pharm, antatomy, or physiology than a standard medical curriculum. Yes, you most likely have more OCULAR anatomy and physiology than most non OMD MDs. You might have more training in OCULAR pathology than most non-OMD MDs. So? Your point? And dentists have more training in oral path than most MDs. And?

BUT...to make a straight-faced argument that an optometrist, in any state, regardless of scope of practice, and regardless of any "residency" program you may have completed, has more training in ocular disease and management than an OMD is ludicrous. I'm sorry, but I find it hard to believe that any light "non-call" one-year cushy residency (sans blood-n-guts, trauma, and triage) in CL or primary care surpasses the knowledge an OMD gains in 4 years of intense, on-call year-round residency treating a myriad of ocular disease and dysfunction, prescribing from all schedules of drugs, opening and closing surgeries every day, and treating post op several times a week. Also, the OMD collaborates with other physicians and health care providers who are treating the patient systemically, on a daily basis, and discussing the patient's systemic health (e.g., neuro, cv, pulmonary, endocrine, psychiatric, OB-GYN) with these professionals. As well trained as IndianaOD might be, he is NOT trained in cv med, neurology, respiratory medicine, OB-GYN, endocrinology, or psychiatry; he does not have the knowledge or training to look at the whole picture and coordinate the health care of the patient.

Since derm came up, what about a patient who's retinas are scarred from burns? What if the eye lids are damaged from fire or acid? Can you effectively and safely coordinate your care with a derm who is treating the facial/orbital injuries? Are you competent to do a debridement of the damaged tissue (externally) that effects the internal area? I doubt it.

You know, working in the mental health field, I frequently hear MSWs and MA's say things like "I could do the exact same thing a psychiatrist does and do a better job." Most of the psychiatrists I know laugh at these statements.

 

[qwopty99]

How could someone who never attended medical school know he "coulda" matched into a derm residency?

Post #4 above:

 

[qwopty99]

bla

 

[eyestrain]

BUT...to make a straight-faced argument that an optometrist, in any state, regardless of scope of practice, and regardless of any "residency" program you may have completed, has more training in ocular disease and management than an OMD is ludicrous. I'm sorry, but I find it hard to believe that any light "non-call" one-year cushy residency (sans blood-n-guts, trauma, and triage) in CL or primary care surpasses the knowledge an OMD gains in 4 years of intense, on-call year-round residency treating a myriad of ocular disease and dysfunction, prescribing from all schedules of drugs, opening and closing surgeries every day, and treating post op several times a week. Also, the OMD collaborates with other physicians and health care providers who are treating the patient systemically, on a daily basis, and discussing the patient's systemic health (e.g., neuro, cv, pulmonary, endocrine, psychiatric, OB-GYN) with these professionals. As well trained as IndianaOD might be, he is NOT trained in cv med, neurology, respiratory medicine, OB-GYN, endocrinology, or psychiatry; he does not have the knowledge or training to look at the whole picture and coordinate the health care of the patient.

I think most of us agree. I also think this whole thread went from zero to ridiculous in record time. I'm so sick of this crap. It's pointless and depressing.

 

[blysssful]

Oh gawd, I hope optometry is not that bad.


Let's say it's like dating that hot chickie's best friend, who's quite cute herself.



This is getting really sexist. This should stop right now...

Bahaha... I DID say I was out of it. I PERSONALLY think Optometry is the bombshell and an MD would be my idea of the fat friend, but hey, that's just me.

I just think some people need to realize that most of people on this site are constantly furthering their education and the pathetic attempts of showing off your "which way to the beach" brain muscles are annoying and immature. Get over yourself.

 

[200UL]

Interesting post that is approaching break down. I had an strange emotional response when reading ProZacks original post – it must have been some of the personal anecdotes. I feel I have to respond to Indiana, however.

I will be the first to say there is nothing too special about MDs or DOs. I am a good example of this. Most in my medical school class are humble people. However, ophthalmology training affords many experiences that ODs will never have. Yes, we read every night and go to lectures on “medical ocular diseases, ocular pharmacology…” but our training allows us to see intense pathology in every lane/every hospital room we enter.

There are different models to how people learn. The allopathic/osteopathic medical system uses a model of lectures, clinical rotations before graduation. Residency builds more specific training with independence and provides surgical training in certain specialties. Before one goes out to practice independently, we must prove competence.

Good residencies in ophthalmology will require at least 60 hours per week devoted to caring for clinical/surgical patients. In my opinion, the best programs can demand more (we can work up to 80 by law in the US). Are optometry schools giving you this opportunity for all four years? I doubt it because posts on this board state optometry school has similar time demands as college. You can ask my family, but ophthalmology training demands about 1000x as much effort/time as college.

Getting back to how people learn… Is going to lecture/reading every night enough to take care of eyes? Can someone recognize and treat a stroke patient after only reading about it? Could one just show up to the SICU and communicate in an efficient manor with the ICU staff regarding the patient’s elevated intracranial pressure? Does one really understand how managing a patient’s blood sugar really works by taking a pharm class or does one gain something by watching a patient’s sugar tank in front of them after an order is written? Could one run a code of a patient that had an anaphylactic reaction after FFA without any ACLS training? Maybe some could do this by just being smart, but the entire US medical system has bought into the idea that it takes a long time/thousands of patient encounters to take care of complex medical diseases. Many in optometry feel the sky is the limit with 4 years of training.

EyeMDs and EyeDOs may differ on their opinions on the length of our training. I, however, feel that all of my experiences have been valuable and these will allow me to “take care of eyes” at a different level. I for one see great differences between ophthalmology and optometry – it is not just surgery. And this difference does not make us worse at “taking care of eyes.”

The other thing I do not agree with is that my residency is devoted to “ocular surgery” only. The majority of the first 1-2 years of ophthalmology training is devoted to learning medical ophthalmology. Yes there is surgical training during this time, but this builds during the later portion of the residency. Also, surgical training/experiences makes one a more proficient medical ophthalmologist (Do you think a neurosurgeon or orthopedists looks at spine disease at a different level than a chiropractor? One cannot learn everything in the cadaver lab or lecture or a textbook. Considering surgery for a patient is a big deal – one needs to know everything about the disease and complications that may or may not be surgical to do it well. Most patients in an OMD office do not have surgery the next day. That means we provide a lot of non surgical care. Sorry, most ophthalmologists probably do a decent job with this.

 

[IndianaOD]

A few points:

1) How does the average OD have 5 years of optical training? Let's be honest here, you have FOUR years of optometry school. Of those 4 years, taking the basic science (anatomy, physio, pathophys, pharm) out of the picture, how many actual YEARS of visual training do you have? 2 or 3? Using your math, you have 5 years. Four years of optometry school + what?

Don't even try to sell that residency bunk here. How many OD's actually do a residency? Also, your residency is VOLUNTARY; it's not required.

So, based on the real numbers, here, you're still better trained in ocular disease and management than non-surg OMDs, who have 3-4 years of specialized residency + internship and rotation + whatever they learned in medical school?

Even with a residency, your OD only has, at best, 3-4 years of actual training in eye disease and management, whereas the OMD has 5+ (1 year med school + whatever rotations/internship exposure to eye disease/mgt + 4 residency).

Nice try.

Zack, unless some changes have taken place recently, general OMDs have 3 yrs of eye residency. I don't believe the trans year is eye centric.

Yes I had a residency, but its becoming more common by the year. During my residency I spent 6 days a week in patient care and the cases were selective because we acted as a referral center.

I don't think I'm better than an OMD (well maybe some ), just better in certain areas just like they are better in others.

 

[IndianaOD]

Good residencies in ophthalmology will require at least 60 hours per week devoted to caring for clinical/surgical patients. In my opinion, the best programs can demand more (we can work up to 80 by law in the US). Are optometry schools giving you this opportunity for all four years? I doubt it because posts on this board state optometry school has similar time demands as college. You can ask my family, but ophthalmology training demands about 1000x as much effort/time as college.

I'm sorry, but this is the rhetoric that keeps me going. Come on. I personally know 2 OD/OMDs. Neither were at the top of their OD class and said the OMD training was time consuming but no more mentally challenging. Over my training I interacted with 4 OD/OMDs. As a curious person I talked to them about the differences. Most of the conversations where while I was helping in the OR.

This thread has degenerated same as usual. Unless I need to address some more ridiclous rhetoric, I'll discontinue contributing to this mess.

 

[KHE]

I'm sorry, but this is the rhetoric that keeps me going. Come on. I personally know 2 OD/OMDs. Neither were at the top of their OD class and said the OMD training was time consuming but no more mentally challenging. Over my training I interacted with 4 OD/OMDs. As a curious person I talked to them about the differences. Most of the conversations where while I was helping in the OR.

This thread has degenerated same as usual. Unless I need to address some more ridiclous rhetoric, I'll discontinue contributing to this mess.

My God,

The tedium of this thread is unbelievable. Nothing but the same old tired rhetoric from the same crew of people who have little to no understanding about the other side trying to convince each other that "they're right" in the most obnoxious way possible. I'm surprised we haven't seen the malpractice statistics posted yet. I'm sure that's only a matter of time. 🙄

Yes....yes....we all get it. You have "many friends" who are MDs and you know all about their training and how they don't know "squat" about the eye and you took the same 1st year physiology class as dental students and thousands of hours of pharmacology classes. 🙄

And yes...yes...we all get it. You spend hundreds of thousands of hours rotating through the geriatric and IC wards and that makes you more qualified than optometrists to use patanol. 🙄

And yes...yes...we all get it. You graduated at the top of your pre-med class and you "chose" optometry and you could have gone into any medical school and any medical residency on the strength of your stellar performance in your pre-med days. 🙄

Seriously guys and girls, for the love of God herself, stop it.

 

[362.04]

KHE,

I concur,

I cannot believe that non-optometrist would want to engage in these forays into this issue on this forum.

I guess they are totally bored or ignored in their own forums.

SUGGESTIONS for outlanders! If you want to contribute,

1. ....do so positively instead of beating one's chest about their own good worth
2. ....support students or posters constructively instead of showing how "smart" you're supposed to be by denigrating students.

 

[swiftiii]

If you want to contribute,

1. ....do so positively instead of beating one's chest about their own good worth
2. ....support students or posters constructively instead of showing how "smart" you're supposed to be by denigrating students.

If these were the rules, we'd only have five posts a day.... 😉

Honestly, I wish sometimes this board could be more constructive. Argue to your heart's content, but only in a thoughtful, perspectful way. It really gets me when people post that they were thinking about optometry, but now weren't so sure after everything they heard here. This wouldn't be so bad (as we want people to think hard and have all the facts before they choose this profession), but I only see this statement when the postings have become extremely negative and argumentative without good facts.

 

[Eyefixer]

This is one of the best posts I've read in a long time! You are one bright individual, ProZackMI.

WARNING: Long-winded verbiage; do not read if you're pressed for time, have a life, or do not expect to live much longer.

I’ve been posting on SDN for about 3 years now, give or take, and in that time, I have had both civil and non-civil discussions about various professions. When I first started here, I was a vocal critic of my own profession, psychiatry. Having seen my specialty decline into the quagmire of known medical specialties, for various reasons, and realizing that I spent 4 years of medical school and 4 years of residency preparing myself for a lifetime of 15-20 minute medication reviews, I began posting on SDN as a way to vent and connect with other dissatisfied psychiatrists. Soon, I began to wander into other fora (psychology, pharm, opto, etc.) and found many other professionals in the same boat as me: looking for love in all the wrong places/unhappy with their career choices/looking for something else.

I honed in on the optometry forum for a few reasons. First, I noticed that more optos than pharms, psychologists, dentists, etc., were unhappy with their chosen profession and posting their frustration. Second, I had two patients who were deeply unhappy about their personal and professional lives; one was a chiropractor who eventually became a high school history teacher and the other, a former optometrist who now works as a PA. The optometrist, a middle-aged guy with two teenagers and a harpy of a wife, was so unhappy with his career, and so bored, he created an active fantasy life for himself and frequently posed an OMD surgeon. In fact, when his mother-in-law was hospitalized with nephrotic syndrome, he actually tried to tell the attending how to treat her and almost got himself in serious legal trouble. He frequently "played doctor". The genesis of his problem was profound regret at not getting into Wayne State for medical school like his brothers and father. He resented optometry, which was merely a fallback career for him, and coveted the life of a physician. Having worked with him for 3 years, I learned a great deal of his PERSONAL SUBJECTIVE view of your profession. When I came to SDN, I saw some of the same patterns in the OD forum.

Many of you on this forum seem to think I’m a rabid anti-Optometrite. Am I really? Am I a true critic of a profession I admittedly know very little about? No, I am not. Do I really give a rat’s ass about what an OD does or does not do? No, I do not. I do not feel ODs are a threat to me personally or anyone in either of my professions. Optometry will never displace psychiatry or law, and in my opinion, it will never displace or replace ophthalmology.

My true problem is not with the professional optometrists who post on this board (except IndianaOD who seems to think he graduated from medical school). It is with the students and college students who have yet to enter the profession (e.g., oculomotor, gochi, and a plethora of others) who entered a profession for the wrong reasons: (1) doctoral title; (2) perceived status/prestige; (3) respect; (4) look cool in a white coat. These students seem to want a back-door entry into the practice of medicine. They seem to be under the impression, much like their chiropractic friends, that they are going to become physicians upon graduation from optometry school and will have a happy, prosperous career ahead of them. Will they? Graduation from any school does not guarantee happiness. Do you know how many MDs and DOs out there are unhappy in their careers? MANY!!!

I think optometry has many benefits over ANY branch of allopathic or osteopathic medicine. Whether you choose retail or clinical optometry, once you finish your education in 4 years, you are done! You do NOT have to undergo clinical rotations in areas where you wouldn’t wish your worst enemy to work (e.g., OB-GYN, general surgery, geriatrics). You do NOT have to undergo internship or MANDATORY PGY residency training. In just four years of OD school, you actually learn how to do your job and do it well. On the MD side of the coin, medical school gives us a tiny portion of the knowledge we need to practice; it’s the PGY training that teaches us how to actually do what we do and do it well!

If you guys want to do a residency, it’s one year and highly focused: contact lenses, primary care, etc. You don’t spend your nights on call. You don’t have to insert your hands into someone’s mouth, rectum, or vagina. You don’t have to worry about blood, vomit, feces, or other bodily fluids. You don’t have to watch people suffering and dying. Yes, even a lowly psychiatrist has done all of this. I also did a residency in IM. I saw a 14-year-old boy die in his mother’s arms due to CLL. I’ve seen MVAs so bad, the victims were barely recognizable as human beings. I’ve seen patients of mine die from self-inflicted wounds in the ER.

An optometrist has a career and a life. A physician, in the US, does not; he/she has a life and it often becomes intertwined with career. You bring the gift of sight into people’s lives. NO ONE is ever afraid to come see you. Even little kids don’t fear ODs. No one enjoys going to the dentist. No one enjoys going to a doctor’s office. Most people hate having to hire a lawyer. Seeing a shrink isn’t usually the top of the list of “things I wanna do today” for most people. Getting a new pair of specs and seeing the friendly, kindly neighbourhood eye doctor is something that most people have no problem doing. No blood, no pain, minimal inconvenience. No waiting. No nasty tests. You rarely have to deliver horrible news to patients. How many ODs really get sued for malpractice? What is your malpractice cost? How many of you optometrists have to testify in court for PROFESSIONAL matters? How many of your patients call you up at 4:00 am after ODing on Xanax or SSRI de jour? How many of your patients sue you because their husband decided to impregnate his niece and blame you for it?

You guys have a great job when you think about it. Yes, it would be nice if your jobs were more “medical” and it would be nice if you could be more like doctors, but there is simply no need for ODs to fill that role or enter that niche. Why compare your profession to dentistry or podiatry? Why compare it to ophthalmology? There is a reason why optometry school grants the OD degree and not the MD or DDS or DPM or whatever degree. You are not dentists, nor are you like dentists. Dentistry and podiatry are actual offshoots of allopathic medicine. Optometry is not and never was; its roots are completely non-medical and evolved over the years.

My point is, be glad you are part of a unique and respectable profession. NO ONE hates optometrists. No one fears optometrists. No one dreads going to see the optometrist. No one dies in your care and your liability is minimal. You meet lots of people and provide a valuable service. No one except you and your mother will give a rat’s ass that you are a “doctor”. Butchers wear white coats too. Your degree and training may be quite advanced, and you may know a lot when you graduate, but in reality, you’ll forget most of it once you begin doing whatever it is you will mostly do. Yes, you are trained. Yes, you know pharmacology and anatomy. No, you are not physicians. No, you are not surgeons. No, you are not LIKE dentists or podiatrists or pharmacists or any other profession. You are an optometrist. If you need to compare your profession to another, audiology is the closest there is to comparison. If, however, you compare and covet the trappings of other professions (e.g., dentistry and medicine), go to medical school or dental school. DO NOT enter optometry because you couldn’t get into medical or dental school. DO NOT enter optometry because being called DOCTOR is cool. Enter optometry because you want to be an optometrist. How hard is that to understand?

Many of you, like qopty, KHE, hello07, and a few others, know your professional strengths and weaknesses, know your training, and are happy with your career choice. I see common sense and true professionalism in their postings. Others are delusional, disgruntled, and overly critical. If you are unhappy in your personal life, you will be unhappy in your professional life. If you are unhappy in your professional life, why? Ask yourself why and seriously attempt to answer the question. The next question should be, "what can I do to make my job/career better/more exciting?" Think about it. Sometimes the answer will surprise you. Sometimes it won't. If you find yourself unhappy, explore and weigh your options. Even if you are older, it's NEVER too late to change, evolve, or try something new. I'm 37. I went from doctor to lawyer once I asked myself that question, "what can I do to make my life better?" At that time, I was 30 and barely out of residency. If my lazy ass can do it, so can you. KHE left optometry to teach high school, if my memory serves. Ask him about change! If you're an OD and unhappy, what about academia? What about consulting? Go back and get an MBA and do optometric management! Get an MSW and be a social worker. There is so much you can do with your degree besides practice. You can teach at the college level, work for government agencies, work for insurance companies, go into management and consulting, etc. If you have a family and student loans, then your options are more limited, but still...do what you have to make life interesting before it becomes too late.

I wish someone had told me this back in 1992 when I entered medical school. I wish I had entered medical school for the right reasons. If you go through your professional life saying “what if” all the time, you’ll never be happy. Avoid EPIC FAIL and do what you want to do in the first place.

 

[200UL]

I'm sorry, but this is the rhetoric that keeps me going. Come on. I personally know 2 OD/OMDs. Neither were at the top of their OD class and said the OMD training was time consuming but no more mentally challenging. Over my training I interacted with 4 OD/OMDs. As a curious person I talked to them about the differences. Most of the conversations where while I was helping in the OR.

I agree with your OD/OMD buddies completely. I don't see anything in OMD or OD school as mentally challenging - if they were, I wouldn't have a shot at either. Working on calculus and critiquing a poem are mentally challenging.

All programs in the health sciences force students to sit down and memorize facts in notes. One takes many tests - if you know everything in the notes you do well. Eventually concepts learned are put into practice. If you did not memorize enough facts in the past or continue to memorize facts, I suppose you would have a lot of mental challenges while trying to take care of patients.

My only point is the average OMD learns a lot about eyes during our "abbreviated" residency training and the concepts are not very abstract. On the medical side of things, nothing that either group (OD or OMD) does is really hard or mentally challenging.

 

[ProZackMI]

This is one of the best posts I've read in a long time! You are one bright individual, ProZackMI.

Thank you! 🙂

 

[ProZackMI]

I agree with your OD/OMD buddies completely. I don't see anything in OMD or OD school as mentally challenging - if they were, I wouldn't have a shot at either. Working on calculus and critiquing a poem are mentally challenging.

All programs in the health sciences force students to sit down and memorize facts in notes. One takes many tests - if you know everything in the notes you do well. Eventually concepts learned are put into practice. If you did not memorize enough facts in the past or continue to memorize facts, I suppose you would have a lot of mental challenges while trying to take care of patients.

My only point is the average OMD learns a lot about eyes during our "abbreviated" residency training and the concepts are not very abstract. On the medical side of things, nothing that either group (OD or OMD) does is really hard or mentally challenging.

You know, reading your response to IndianaOD made me think of a conversation I had with a friend and fellow physician a few years ago. He asked me what the main difference between medical (allo) and law school was in my opinion. I thought about it and told him that medical school was no more than an extended undergraduate science curriculum, whereas law was a true graduate curriculum. Of course, this made him upset and he demanded to know how a JD could be more difficult than an all mighty MD.

I pointed out exactly what you did in your above post. Medical school, just like dental school, vet school, optometry school, and MOST professional degrees, emphasizes memorization and regurgitation of facts; there is VERY LITTLE research or analysis involved in the academic process.

In medical school, I never had to write a paper. I memorized facts, took test after test, went to labs, etc. I did rotating clinicals and had hands-on-experience as well. I did not engage in significant intellectual analysis of the facts I was learning. I did NOT do much research (very little in fact). I'm thinking back and I can honestly say I did not write any papers in medical school. I had a family medicine class that required some writing, but nothing compared to graduate school or law school.

YES...make no mistake, medical school was difficult, time-consuming, and arduous. However, for a person who's good at memorization and does well on tests, it wasn't that difficult. Law school, however, from day one, forces you, the student, to read a huge amount of material, memorize it, regurgitate it, AND process it. Yes, this is the law, but WHY and what does it mean? How did the court come up with its reasoning? ANALYSIS, ANALYSIS, debate, processing. The work of a true graduate degree. In my law program, I had to write, write, write. I had to think, think, think....not just puke up answers and do well on exams and labs. In law school, you never rest, you always work and you always think.

Contrast that with medical school where you always work, but seldom question why or think about what you're learning. You just memorize and puke it back to the professor. In your clinicals, you apply some of the knowledge you learn, but truthfully, it's not until you're a resident that you actually integrate your knowledge and engage in some analysis. It wasn't until residency where I said "OMG, I get it!" and learned how to be a doctor. I certainly did NOT learn to to be a physician in medical school. My MD is nothing more than a puffed up undergraduate degree.

In fact, in college, I was not pre-med. I did a specialized master's program in bio-med science to prepare me for medical school. Many of the classes I had in graduate school were far more advanced than in med school. My gross anatomy classes were much more in depth than they were in medical school, so was my pathology and histology class. I know a few people with PhDs in the biomedical sciences and they sure know a great deal more than I do about the biomedical sciences. They, having gone through an intense graduate program, learned how to analyze facts, process information, conduct research, and above all else, THINK about the science they were learning.

Professional school does not truly allow the student to think much about what it is he/she is learning, just rote memorization and testing.

So, that's why I say an MD or OD or DDS or other similar health-related "doctorates" are, at best, inflated undergrad degrees. A JD, in my opinion, is a true graduate degree, perhaps not at the same research level as a PhD, but it is a thinking, analytical degree for sure. Length and difficulty of programs, like an MD program, are not true indicators of the degree.

So, next time anyone on this board gets all uppity about their training, you might want to take a moment to reflect that your "graduate" professional training, while intense and arduous, was NOT a true graduate program insofar as you did not learn how to think, analyze, or research, but you merely learned a great deal of information in 3-4 years of intense memorization and regurgitation coupled with some clinical hands-on work.

How many optometry students wrote lengthy research or analysis papers? How many optometry students were trained to research while in "graduate" school? I know very few medical students did any of this.

 

[qwopty99]

My MD is nothing more than a puffed up undergraduate degree.

Man, this line can be taken totally out of context in the wrong hands.

 

[curious cat]

Whenever I see posts about someone who is an OD and OMD talk about their ophthalmology training and saying it wasn't very mentally challenging, I just laugh. You only think that they have the unique perspective of training in both, and thus, are able to accurately describe how difficult it is to go through each one. However, what you are missing is that their ophthalmology training isn't identical to what it is for someone who is coming in cold. After all, they have already gone through optometry school and know a decent amount about the eyes. So when they are learning ophthalmology, it is not their first time like it is for typical ophthalmology residents.

For example, let's say we somehow could coax an ophthalmologist to go to optometry school. How challenging would that be for him/her? I would be willing to bet that he/she would say it wasn't that difficult. Is his/her viewpoint on optometry school then a valid representation of what an average optometry student is going though?

As far as I know, all OD/OMDs went to optometry school first, and not the other way around. So since they already had some eye training, their viewpoint is no longer comparable. Arguing otherwise just shows a lack of analytical abilities.

 

[Dr.Millisevert]

Man, this line can be taken totally out of context in the wrong hands.

But interesting thought. I never viewed the MD (or OD etc.) in this manner, but I guess that is one way to look at it. I haven't completed a "graduate" degree, so I don't have anything to compare to, so I'll have to take your word on it.

The United States is the only country in the world that actually classifies the MD as a "graduate degree" (even if in other countries they also require a previous degree before admission). Even in Canada who's medical schools are also accredited by the LCME, all of their MD programs are in Canada classified as "undergradate".

(something to think about)

I think the same situation exists for all other professional degree programs as well. (optometry included)

 

[IndianaOD]

I agree completely Zack. IMO the hardest thing about OD school was the optics...lots of problem solving and math. Otherwise you are correct, really all you need to do is regurgitate stuff. There are some though who can't put the knowledge together and are awful clinicians. I helped fail 2 students who needed remediation while on faculty.

Really, I think all the doctorate programs should decrease some of the didactic to give more time to hands on learning.

While I do think you need some scrap of intelligence to make it through the doctoral programs; determination is more important. Just pushing through all the material.

What's the saying?

"A" students should do research
"B" students should teach
"C" students should be the clinicians

I spent a year as an R&D research scientist. Interacting with a bunch of PhDs does keep the mind going!

You know, reading your response to IndianaOD made me think of a conversation I had with a friend and fellow physician a few years ago. He asked me what the main difference between medical (allo) and law school was in my opinion. I thought about it and told him that medical school was no more than an extended undergraduate science curriculum, whereas law was a true graduate curriculum. Of course, this made him upset and he demanded to know how a JD could be more difficult than an all mighty MD.

I pointed out exactly what you did in your above post. Medical school, just like dental school, vet school, optometry school, and MOST professional degrees, emphasizes memorization and regurgitation of facts; there is VERY LITTLE research or analysis involved in the academic process.

In medical school, I never had to write a paper. I memorized facts, took test after test, went to labs, etc. I did rotating clinicals and had hands-on-experience as well. I did not engage in significant intellectual analysis of the facts I was learning. I did NOT do much research (very little in fact). I'm thinking back and I can honestly say I did not write any papers in medical school. I had a family medicine class that required some writing, but nothing compared to graduate school or law school.

YES...make no mistake, medical school was difficult, time-consuming, and arduous. However, for a person who's good at memorization and does well on tests, it wasn't that difficult. Law school, however, from day one, forces you, the student, to read a huge amount of material, memorize it, regurgitate it, AND process it. Yes, this is the law, but WHY and what does it mean? How did the court come up with its reasoning? ANALYSIS, ANALYSIS, debate, processing. The work of a true graduate degree. In my law program, I had to write, write, write. I had to think, think, think....not just puke up answers and do well on exams and labs. In law school, you never rest, you always work and you always think.

Contrast that with medical school where you always work, but seldom question why or think about what you're learning. You just memorize and puke it back to the professor. In your clinicals, you apply some of the knowledge you learn, but truthfully, it's not until you're a resident that you actually integrate your knowledge and engage in some analysis. It wasn't until residency where I said "OMG, I get it!" and learned how to be a doctor. I certainly did NOT learn to to be a physician in medical school. My MD is nothing more than a puffed up undergraduate degree.

In fact, in college, I was not pre-med. I did a specialized master's program in bio-med science to prepare me for medical school. Many of the classes I had in graduate school were far more advanced than in med school. My gross anatomy classes were much more in depth than they were in medical school, so was my pathology and histology class. I know a few people with PhDs in the biomedical sciences and they sure know a great deal more than I do about the biomedical sciences. They, having gone through an intense graduate program, learned how to analyze facts, process information, conduct research, and above all else, THINK about the science they were learning.

Professional school does not truly allow the student to think much about what it is he/she is learning, just rote memorization and testing.

So, that's why I say an MD or OD or DDS or other similar health-related "doctorates" are, at best, inflated undergrad degrees. A JD, in my opinion, is a true graduate degree, perhaps not at the same research level as a PhD, but it is a thinking, analytical degree for sure. Length and difficulty of programs, like an MD program, are not true indicators of the degree.

So, next time anyone on this board gets all uppity about their training, you might want to take a moment to reflect that your "graduate" professional training, while intense and arduous, was NOT a true graduate program insofar as you did not learn how to think, analyze, or research, but you merely learned a great deal of information in 3-4 years of intense memorization and regurgitation coupled with some clinical hands-on work.

How many optometry students wrote lengthy research or analysis papers? How many optometry students were trained to research while in "graduate" school? I know very few medical students did any of this.

 

[qwopty99]

You bring up a good point, but like you say, your sample size is non-existent.

 

[ProZackMI]

Man, this line can be taken totally out of context in the wrong hands.

But interesting thought. I never viewed the MD (or OD etc.) in this manner, but I guess that is one way to look at it. I haven't completed a "graduate" degree, so I don't have anything to compare to, so I'll have to take your word on it.



Curious though - I know there are currently efforts underway to make medical curriculums more analytical, more deductive e.g. the shift to problem-based learning. I'm not sure when you graduated from medical school, but I imagine it was a few years ago, and probably before the "big" shift currently underway in many medical curriculums. Do you think it's possible that medical school NOWADAYS is more like the "graduate" school you refer to, moreso than in the past?

I graduated from medical school in 1997. At my school, we did have some problem-based classes, but, by and large, it was primarily very similar to undergraduate science type of learning: memorization, testing, and labs/clinicals.

I have read some articles about reform of medical education, but to answer your question, no, I do not believe your standard MD program today is more like graduate school. I suspect that unless the AMA overhauls its standard curriculum, it will never change much.

Let me pose this question to you and all who frequent this board. Why is medicine different from optometry and vet med and dentistry? What I mean is this. Let's use dentistry and optometry and vet med as examples. TYPICALLY, your average dentist graduates from dental school in 3 or 4 years (there are 3 year DDS programs), takes a licensing exam, passes, and then enters practice. Your typical OD does the same after graduating. Same with your typical vet. Yes, there are residencies available, but those are optional and only if one wishes to specialize.

However, your typical vet, optometrist, and dentist is able to safely and competently practice effectively right after graduation. It takes some time to become acquainted with the job, but by and large, no problems. Why do physicians NOT learn how to be physicians until residency? Why can't we learn to be physicians in 4 years like optometrists, dentists, and vets? If we want to specialize, we can do a voluntary residency like you guys.

I know the answer, but I'm trying to see if anyone else wishes to tackle this? What do you think?

 

[qwopty99]

I know the answer, but I'm trying to see if anyone else wishes to tackle this? What do you think?

What is the "answer" you are looking for. That MDs "learn more basics"?

If that's the "answer", it's entirely possible. I'd even say it's likely, almost certainly, the case.

I had like 50% classes in 3rd year, and almost none in 4th year. Book learning was basically done after 2nd.

 

[blysssful]

However, your typical vet, optometrist, and dentist is able to safely and competently practice effectively right after graduation. It takes some time to become acquainted with the job, but by and large, no problems. Why do physicians NOT learn how to be physicians until residency? Why can't we learn to be physicians in 4 years like optometrists, dentists, and vets? If we want to specialize, we can do a voluntary residency like you guys.

I know the answer, but I'm trying to see if anyone else wishes to tackle this? What do you think?

This is coming from someone still in undergrad, so it's just a guess here... but an MD degree without a residency seems kind of ridiculous (which is what I'm assuming you're alluding to). Dentists and optometrists generally deal with one system of the body...whereas an MD is supposed to be competent in all matters of the body (or at least be equally exposed to all matters of the body). If three/four years is the agreed upon time to become diligent in one system then it stands to reason that it would take significantly more time than that to become competent in many/all systems.

Stupid analogy time: If I spent four years of my life learning every possible thing there is to know about the left index finger, and you spent four years of your life learning about the entire anatomy, I'd be far more knowledgeable about that index finger. That's the idea, anyway.

 

[Dr.Millisevert]

Why do physicians NOT learn how to be physicians until residency? Why can't we learn to be physicians in 4 years like optometrists, dentists, and vets? If we want to specialize, we can do a voluntary residency like you guys.

It used to be like that in the US back in the 60s. By that I mean.. you could come out of medical school and basically work as a Family doctor. It wasn't until 1969 when the American Board of Family Medicine was created and created and required a residency to be completed prior to being recognized as a specialist in "family medicine".

👍

 

[ProZackMI]

What is the "answer" you are looking for. That MDs "learn more basics"?

If that's the "answer", it's entirely possible. I'd even say it's likely, almost certainly, the case.

I had like 50% classes in 3rd year, and almost none in 4th year. Book learning was basically done after 2nd.

👍
In part, yes. It has to do with systemic treatment of multi-systems. Not necessarily more "basics", but more basics about everything. This takes longer to learn, but it's not impossible. Vets do it, right? So, why is medicine different? Why the need for a residency, especially in IM or FP?

 

[ProZackMI]

This is coming from someone still in undergrad, so it's just a guess here... but an MD degree without a residency seems kind of ridiculous (which is what I'm assuming you're alluding to). Dentists and optometrists generally deal with one system of the body...whereas an MD is supposed to be competent in all matters of the body (or at least be equally exposed to all matters of the body). If three/four years is the agreed upon time to become diligent in one system then it stands to reason that it would take significantly more time than that to become competent in many/all systems.

Stupid analogy time: If I spent four years of my life learning every possible thing there is to know about the left index finger, and you spent four years of your life learning about the entire anatomy, I'd be far more knowledgeable about that index finger. That's the idea, anyway.

Yep, you're on the right track here! 🙂

 

[ProZackMI]

It used to be like that in the US back in the 60s. By that I mean.. you could come out of medical school and basically work as a Family doctor. It wasn't until 1969 when the American Board of Family Medicine was created and created and required a residency to be completed prior to being recognized as a specialist in "family medicine".

👍

Bingo! The dentist hits the nail on the head! You drilled right into the cementum and hit nerve, my friend. 👍

There are a few parts to the answer:

1) It's a money making industry, medical residencies
2) It's cheap or "free" labour for hospitals
3) It's difficult to teach systemic multi-system medicine in 3-4 years of didactics;
4) The AMA likes it because it sets medicine apart from other professions by making a residency mandatory to practice.

In some countries, one can practice medicine immediately after graduating (from an undergraduate program), right from high school, or with only 2-3 years of college/university prior to medical school. A "residency" is actually an apprenticeship type of deal.

In the US, back in the day, docs never had to undergo residency training, and based on the knowledge base of the day, did a safe and effective job treating their patients. Of course, there were far fewer specialities back then.

Specialization has changed medicine drastically. In some cases, it's not necessary. In some, it is.

The AMA's Council on Medical Education has proposed some possible changes to allopathic programs that might help the future of medicine. Current medical practice in the US has many challenges. I think we can guess what some of these are:

1) Proliferation of poorly trained FMGs flooding the "market". I challenge anyone on this board to enter any city in the US, even in rural areas, and NOT find a physician, dentist, or specialist from India, China, or the Middle East. I'm not saying this to be racist, or to say ALL FMGs are poorly trained, but by and large, the most medical malpractice cases in the US come from these folks, who often only have a foreign-earned medical degree, and have difficulty communicating with patients. In my specialty, psychiatry, I would guess that about 85% of all practicing psychiatrists, at least in MI, OH, IL, and maybe PENN, are of Indian or East Asian extraction. This creates a huge problem with patient communication. In psychiatry, it's especially important to understand your patients (language wise and culturally) and more importantly, to have your patients understand you. FMGs in general pose a challenge to US-trained docs. They are cheaper, willing to work in MUA (medically underserved areas like inner cities and rural areas), accept Medicaid, etc. How many US-trained docs do inner city work or country bumpkin work? How many US-trained docs take Medicaid patients regularly? See my point? Good on one hand, bad for medicine in other respects.

2) More mid-levels creeping up and taking over functions previously controlled by MDs or DOs. PAs and NPs have in many ways diminished the practice of family and internal med; it's lost it's lucre and status in the medical community. Now NPs have DNP degrees and are fighting hard for unrestricted practice rights. It will happen eventually. Also, psychologists, optometrists, PTs, pharmacists, and even audiologists are fighting hard to expand their scope of practice. In pharmacy, many PharmDs with residencies have RxPs with or without physician protocol/supervision, can perform physical assessments, order labs, etc. These pharmacists are known as CPPs (clinical pharmacist practitioners) and are found in some states in MUAs. In the VA, many of these pharmacists practice safely and effectively.

In optometry, as you know, many are fighting for full prescriptive authority, from abx, orals, narcotics...everything! Some are fighting for residencies that teach surgery and more medicalization of optometry. In audiology, the argument is, if the optos have RxPs, why can't we treat otitis media, diagnose infections, etc.? After all, we are now Doctors of Audiology. ODs are possibly a challenge to OMDs and eventually, with increased lobbying and support from the insurance companies, AuDs will become a challenge to ENTs/otologists. Give it time.

PTs are now DPTs (Doctor of PT). They want direct access to patients (without an MD/DO referral). They also want autonomy in ordering imaging (MRI, CT, XR, etc.). They might encroach upon PM&R one day, who knows?

CRNAs are displacing anesthesiologists in some areas, and certified nurse midwives are trying hard to become the primary OB-GYN practitioner. In time, they'll succeed.

Psychologists with post-doc training in psychopharm have full RxPs in LA, NM, and I believe HI. Bills are in place to allow these medical-psychologists, or "psychological physicians" to practice, unlimited, with full RxPs in other states (WA, OR, CA, ID). In time, the AMA will stop opposing this as it did with ODs and others. Since there are so few med students entering psychiatry, there actually is a need for this type of provider as PCPs, IMs, and FPs are not trained to be psychiatrists and Rx psychotropics. The psychologists argue that if they have training in basic PE and pharm, how are they different from dentists, pods, and optos who safely prescribe?

Once that happens, psychology will become psychiatry, then the MSWs and MA/LPCs will want psychometric testing privis.

3) Managed health care/insurance companies pay less and force physicians to spend less time with patients for less money. So, when the NPs and PAs say, "hey we listen to you, we're cheaper, and we don't make you wait as long", guess what? Yep, more people go to see an NP or PA or other practitioner and are killing off internists and FPs. Managed health care in general has ruined the lucre and status of medicine IMO.

Some of the reforms suggested by the AMA Council of Medical Education are:

1) lessen the rigid admission standards into allopathic programs, more like many DO programs.

2) lessen the pre-med requirements (physics, calc, and inorganic chem are not relevant to the practice of medicine) and increase pre-med classes in English, communication, and writing.

3) Reduce the M1 and M2 basic science curriculum and increase the clinical and diagnostic component earlier, thereby forcing true problem-based medicine into every year of medical school.

4) Reduce the residencies in some specialities.

5) Offer 3 year MD degrees with reduced residencies for students going into primary care, like the LECOM model in Pennsylvania (DO in 3 years, FP residency in 2 for a total of 5). This would reduce the stress and financial obligation of medical students.

6) Incentives to get students into medicine and reduce their financial burden. If med students graduated with less debt, perhaps they'd enter MUAs like inner cities and rural areas more and not want to specialize and earn a ton to pay back those loans. Less debt = more altruism = win-win = less need for FMGs and mid-levels.

These are just some of the reforms being tossed around out there. If something does not change soon, in 20 years, psychiatry, IM, FM, PMR, OB-GYN, and many other specialities will be killed off. The doctor of tomorrow will be a nurse, psychologist, and who knows what else. Without reform, medicine will continue to suffer.

So, if you optometrists are questioning your choice of careers, consider all of that. Your opportunities will grow, whereas MDs and DOs will continue to slide into the quagmire of manged care.

 

[Dr.Millisevert]

1) but by and large, the most medical malpractice cases in the US come from these folks, who often only have a foreign-earned medical degree, and have difficulty communicating with patients.

I agree with pretty much everything you've said.. just a couple of things I wanted to go over.

The part that is bolded. Please correct me if I've misunderstood, but it sounds like you're saying that most all doctors that get sued in the US are IMGs. Do you mean in every specialty and field of medicine? Do you have any sources for that claim?

In my specialty, psychiatry, I would guess that about 85% of all practicing psychiatrists, at least in MI, OH, IL, and maybe PENN, are of Indian or East Asian extraction. This creates a huge problem with patient communication. In psychiatry, it's especially important to understand your patients (language wise and culturally) and more importantly, to have your patients understand you.

Well... Not every US grad wants to go into Psyc.. same goes for FP. I do agree that they should be creating more incentives for US grads to enter these fields. 👍

The US is full of immigrants (not just doctors). I do think it is beneficial to these populations to have a Psyc or FP who can relate to their culture too. I do understand what you're saying and I do agree that in some areas it is disproportionate.. as you've mentioned. However, (just as an example) I do think having a few Indian Psycs being able to service areas of the US with large Indian immigrants actually helps!

Just a few thoughts

 

[ProZackMI]

I agree with pretty much everything you've said.. just a couple of things I wanted to go over.

The part that is bolded. Please correct me if I've misunderstood, but it sounds like you're saying that most all doctors that get sued in the US are IMGs. Do you mean in every specialty and field of medicine? Do you have any sources for that claim?



Well... Not every US grad wants to go into Psyc.. same goes for FP. I do agree that they should be creating more incentives for US grads to enter these fields. 👍

The US is full of immigrants (not just doctors). I do think it is beneficial to these populations to have a Psyc or FP who can relate to their culture too. I do understand what you're saying and I do agree that in some areas it is disproportionate.. as you've mentioned. However, (just as an example) I do think having a few Indian Psycs being able to service areas of the US with large Indian immigrants actually helps!

Just a few thoughts

To answer your first question, it's rather anecdotal evidence I have seen as an attorney in practice the last 3 years. I left medicine for law. I work with many malpractice attorneys (both plaintiff and defense) and have directly seen the evidence, at least in MI, OH, IL, IN, and PA where FMGs are sued more often, across specialties, especially in the area of informed consent. Is this evidence dispositive? No. Does this evidence equal fact? No. It's based on my objective experience, subjective interpretation, and objective experience of colleagues who practice law.

Very few US grads enter psychiatry these days. Psychiatry is the bottom of the rung of the medical specialties. For many medical students, doing 20 minute med reviews and adjusting meds and writing scripts is NOT practicing medicine. I have to agree with this. Why spend 8 years in training to be a script machine and pill pusher?

Now, I disagree with your last point. While some Indians and Asians do seek mental health tx, most do not due to cultural issues. Thus, the Indian and Chinese psychiatrists out there typically are treating African-Americans, poor whites, and Hispanics/Latinos, NOT other Indians or Asians. In the suburbs, these FMGs are treating middle-class whites, blacks, and some Asians.

Just think, deep in Appalachia, or in the Upper Peninsula of Michigan, or in inner city LA or Chicago or Detroit, how many Indians and Asians do you find? However, in those areas, most of your doctors, in any specialty, will be Indian, Chinese, and Arabic. That does not mean they are inferior physicians, but...it does pose problems, especially in communication.

Have you ever called Sprint's Customer Service? In 4 years, I have yet to find a customer service rep without a heavy Banagalorian or Dravidian accent. I have difficulty understanding these folks, how do you think an African-American with MDD or schizoaffective d/o is going to respond to a psychiatrist with the same accent? Or Billy-Bob from Appalachia?

 

[blysssful]

👍
In part, yes. It has to do with systemic treatment of multi-systems. Not necessarily more "basics", but more basics about everything. This takes longer to learn, but it's not impossible. Vets do it, right? So, why is medicine different? Why the need for a residency, especially in IM or FP?

Egos and money issues aside, I think vets SHOULD have to go into a residency program.

Random personal sidenote for this assertion: I'm a huge animal rights advocate, and I understand that the majority of people do not share this concern. I understand that realistically animals cannot be treated with the same rigor of health care afforded to humans because they can't vocalize small changes in their health, and that it's simply not cost effective to screen animals the way that humans are screened.

 

[blysssful]

1) Proliferation of poorly trained FMGs flooding the "market". I challenge anyone on this board to enter any city in the US, even in rural areas, and NOT find a physician, dentist, or specialist from India, China, or the Middle East. I'm not saying this to be racist, or to say ALL FMGs are poorly trained, but by and large, the most medical malpractice cases in the US come from these folks, who often only have a foreign-earned medical degree, and have difficulty communicating with patients.

My family is from Iran, and while I grew up here, I can offer a little bit of prospective. The high school curriculum (in Iran specifically) is extremely intense compared to the US. Physics, Organic Chem, core biology courses are all taken in high school, NOT undergrad. These aren't AP/IB classes; everyone looking to go into some sort of science after high school takes these courses (for example, my father went into mathematics, but was still required to take physics and organic chem in high school). The testing to even get INTO an undergraduate program is much, MUCH more selective. However, their professional programs are not as rigorous, and many are way behind the technology curve (not a big surprise). They definitely don't address matters of bedside manner, or basically anything else that would be considered non-scientific, and therefore "unnecessary".

My point is that in many of these countries, most of the "weeding out" is done at the post-high school level, whereas in the US pretty much any high school graduate (or GED equiv) can get into some sort of college program.

If you want to compare an American high school student to an abroad student, the abroad student will surely have more under his belt. However, realistically, how much does the average person retain from their high school courses? When these same basic courses are taught at the college level, they will more than likely be more intense.

What I'm trying to say is that the years spent learning the material cannot be considered equal if the maturity level isn't equal. Spending 4 years in high school learning material that someone else spends 4 years of college learning will not, under most circumstances, be equivalent.

 

[200UL]

Interesting comments.

I want to emphasize a couple of things. First, while doing well on written tests in professional school involves memorization, being great in the clinic forces one have the ability to apply what is learned. Some people do this better than others - this does come out in clinical rotations and becomes ridiculously obvious in residency. We have all seen the one that aces the tests, but cannot apply it to patients for various reasons (I have found this to be rare in my experiences, however). On the other hand, if one does not know the facts, they do not have a prayer (One cannot use strong interpersonal skills and fake their way through good patient care. You may fake the patient out, but that doesn't count).

Second, I have family members and friends who have taken the DAT, LSAT, OAT, and. The MCAT is a test that not only tests your knowledge base, but I feel one could extrapolate raw intelligence from it as well. For example, the reading section on the MCAT is mentally challenging. I know people that have done very poorly on the reading section of the MCAT and did very well on the LSAT. My point is (and I can only speak for medical school and the MCAT since I have only seen practice DAT and OAT materials), people that do well on the MCAT tend to be able to handle many "mental challenges" - even if the first 2 years of medical school just forces them to sit on their ***** in the library memorizing thousands of pages of notes.

Finally, I have a question for ProZack. I agree 100% that law school is forces one to think. However, I feel that one could predict who does well in law school before classes even start (based on entry LSAT, entry IQ). The people that must study the most in law school don't always do the best. Sure the top 10% of a class probably work hard, but many of the people out on the town regularly (and not in the library) are able to do well with less work than one may think (they rely on raw intelligence, analytical skills, writing). I think law school, medical school, and optometry school (and other professional schools) are all challenging from a time commitment stand point. My question is - could a "natural" get away with less effort in law school compared with other professional schools (ie medical school)?