what is going on in the legal battle? I have not received or read any new information as to each case. Is board certification here to stay? Anyone know anything please let us know.
Anyone know any updates AOS versus AOA and
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A far better place to get the latest on this issue is odwire.org. There are several posters on there who are directly involved in the proceedings. I haven't been keeping up, but as far as I know, you can spend the time and money getting board certified if you want, but you can't present yourself to patients as a board certified optometrist in any way, whatsoever.
In which state will board certification make any difference if any?
Jason, what exactly is the purpose for becoming board certified? My understanding is it has nothing to do with clinical advance competency whatsoever. Is it for medical panel and all medical billings purposes?
General consensus among academic OD's across the 19 schools and colleges of Optometry?
If any OMD's are reading this, what are your thoughts on this? Do you laugh at us (perhaps not in our face but behind it)?
Tell me........
Jason, what exactly is the purpose for becoming board certified? My understanding is it has nothing to do with clinical advance competency whatsoever. Is it for medical panel and all medical billings purposes?
General consensus among academic OD's across the 19 schools and colleges of Optometry?
If any OMD's are reading this, what are your thoughts on this? Do you laugh at us (perhaps not in our face but behind it)?
Tell me........
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Optometry is heading more medical. Board certification is here to stay and will take on a larger role. NY will get orals and lasers/injections will be allowed to be utilized by ODs in more states. I don't think the OMDs are laughing about this.
What type of lasers are you talking about? YAG capsu. and iridotomies? PRP ? retinal work seal holes ? LASIK? And what type of injectiosn are you refering to? tx a chalazion w/ steroid or tx AMD?
"Board certification is here to stay and take on a larger role." Who told you this? According to the AOS, from what i just read; there is a decline in interest from becoming board certified. Very few have interest in ..........certification. Do you realize this has divided our profession more than ever?
And if NY gets orals, how many ODs are going to be treating what? preseptal ? Meibomian gland dysfunction? You're going to give orals to reduce IOP's after topical have been exhausted or in conjunction?
Where are you getting your info from bro?
"Board certification is here to stay and take on a larger role." Who told you this? According to the AOS, from what i just read; there is a decline in interest from becoming board certified. Very few have interest in ..........certification. Do you realize this has divided our profession more than ever?
And if NY gets orals, how many ODs are going to be treating what? preseptal ? Meibomian gland dysfunction? You're going to give orals to reduce IOP's after topical have been exhausted or in conjunction?
Where are you getting your info from bro?
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Senior ODs, general logic. No posterior lasers now, only anterior seg. No AMD tx, maybe chalazion injections in more states. Basically what a few states have now, more will have it in the near future.
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It doesn't make any difference in any state, as far as I know. We can thank the AOS for stepping up and body-slamming the ABO on that one. At first glance the BC thing might look fine on paper, but the whole thing is basically one giant scam designed to line the pockets of the ABO and indirectly, that AOA. We're all generalists. There are no specialist ODs, no matter what anyone would like to think.
In my mind, the ridiculousness of the debate stems from the fact that we have no defined specialties as you find in medicine, dentistry, and some other fields. If you do a residency in orthodontics, you are now an orthodontist and you are allowed to hold yourself out as a specialist. You are also not permitted to do general dentistry anymore so long as you hold yourslef out as a specialist. In that setting, BC sets you apart as an accomplished specialist who has recieved advanced training in a focused area, and you've proved your competency by taking a series of exams. You can set yourself apart from other specialists in your area by demonstrating that you've been certified by whatever "board" that you've been trained to a certain level and can demonstrate competence beyond the basics.
In optometry, BC is meaningless. We're getting an OD, passing NBEO, and then saying, "Hey, I want to take another test that says I"m even cooler than I was when I graduated." No residency required. No specialised traning required. Just pass another exam. Oh, and don't forget to shell out a few thousand bucks to the ABO in the process.
The nonsese about insurance companies requiring BC is just that, nonsense. I've spoken with several industry reps and they've said that claim was coming from the AOA/ABO, not internnaly from any insurance companies. It's all a ploy to increase revenue for an organization that's losing money due to declining membership as more and more ODs realize their money is being thrown away with AOA dues. It didn't used to be that way, but it is now.
As far as the schools attitude, I think it's more positive than out in non-academic settings. Every OD I know who has taken the exam was tied to academics in some way, if that tells you something. I don't know a single private OD who decided it was a good idea and I don't know of one who even thinks it's a good thing for optometry.
As usual, we put the cart before the horse. If we want to sit at the "big boy" table, we need to have defined specialties. Unfortunately, specialty practice in optometry is not feasable, in my opinion. You have your few ODs who limit their practice to low vision or VT or whatever, but they really aren't truly limiting their practices. They still do some general optometry in most cases. It's not practical for an office to do "just contacts" or "just ocular disease." It just can't work - not with optometry in its current state. But our leadership in optometry doesn't make decisions based on reality, they make decisions based on appearances and what they "want." Honestly, they behave a lot like some of the inexpereinced students on this forum. They hear what they want to hear and do what they want to do without regard for the situation.
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No, not laughing. We relatively recently were forced to adopt a MOC system, rather than the tried and true BC plus CME requirement. Of course, the old guard grandfathered themselves out of the new system, so only the newer docs have to recertify with all the rigamarole that comes along with it. General consensus is that it's a money-making venture for our BC group, as well. The MOC exams are a joke, but an expensive one. So, no not laughing...sympathizing. Of course, our BC is required in most cases to obtain hospital privileges and join some insurance panels, so it seems to serve a purpose, at least. Of course, some like Rand Paul don't hold the official BC without apparent consequences.
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I'll just add that I read on the ABO website that to sit for BC testing, an OD must attain points - 150 pts - I believe. Points are attained by completing OD continuing education courses, or just practicing optometry, among other ways. A low amount of 'points' are awarded for courses or practicing. Residency completion awards BC candidate 150 points - so if you are doing a residency or have completed one, BC is (afaik) another test away. That may explain why academic ODs go for it.
Again, I'll admit I'm really still watching and learning about the whole OD BC issue.
https://www.americanboardofoptometry.org/GetCertified.aspx
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You don't seem to be making any of your claims based on anything, and none of what you've "predicted" hinges on the notion of optometrists' being "Board-certified." If you say, "in the future, practice-rights will expand," you're almost certain to be correct that's simply what tends to happens. Yes, New York probably will get P.O.-medication rights, at some point, but that has nothing to do with Board-cert. they've been after it for years.
As for lasers, it's anyone's guess when which state will give in, but, personally, I don't believe, within the next ten years (i.e., by 2022), any more than six or seven will grant such privileges.
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I agree Board certification, in optometry, doesn't seem to be a very good idea. I do disagree, though, that specialty is not feasible. In my view, there reasonably could be branches such as paediatrics, contact-lens/ant.-seg., posterior pathology, neuro-optometry, etc. The problem is, an O.D., by the nature of her program, will be grossly limited even in the most liberal states in her ability to treat problems; therefore, it might not be very sensible for someone to "specialize" in retinal disease, when a general optometrist could and would just as a easily as a "specialty O.D." refer to an appropriate ophthalmologist.
The only possible merit I see to renewable Board cert. is demonstrating continued competency: doctors shouldn't simply stop learning upon being graduated. Of course, whether Board cert. is the best means by which to achieve this goal, is debatable.
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I don't understand what you're saying. You state that you disagree that specialty divisions within optometry are not practical, but you then say it's not practical due to the limited practice scope in most states.
The problem with specialty practice within optometry is not primarily related to practice scope, in my opinion, except maybe in the case of ocular disease. The problem is related to the fact that we have far too many ODs in practice to make it a reality. If I want to specialize in CLs only, I have to give up my primary care practice. There is absolutely no way to keep the lights on by only doing CL work since I'd be mostly relying on other ODs and MDs to send me CL fits which they would happily do themselves. If I try to attract patients directly, why would they want to split up and see two docs when they can see one and get the same result? It can't happen. Same with retinal disease. Same with pretty much any other area of optometry. It's a matter of practicality. It just won't work. Initiate specialty practice within optometry and you'll see infighting like never before as the already over-packed OD market gets even more cut throat.
As for BC as a means of maintaining competence. We already have a means of maintaining competence - CE. It works fine and to my knowledge, every state requires it to some extent. We don't need an expensive, centralized test that will cost practitioners thousands of dollars. It makes no sense, no matter how you look at it.
BC is a farce that is trying to make optometry appear to be something that is isn't. Throwing together a fly-by-night "ABO" and then slapping BC into the mix doesn't make optometry anything different than it was before. This is a profession without defined specialties. If we want to change that, we have to change the profession from the ground up. That means cutting enrollment, closing schools, and creating a training model that supports specialites. We don't have that now - not even close.
Stop and think about why the ABO appeared out of nowhere. Why is it here? Why did the AOA create it? Could it be....just maybe...that the AOA is running out of cash due to declining membership levels and they're trying to stay afloat? Think about the reasons behind what you see out there and things become much clearer. It's all about making money. Unfortunately, they're trying to profit off the backs of the people who support them. Not a very smart tactic.
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Which medical co-pay do patients pay when they see you? Primary care of the eye is an OD creation. ODs are specialists of the eyes although low level specialists. Higher sub-specialists are the comprehensive OMDs and even higher are the fellowship trained OMDs. It would be nice if all referrals for eye stuff went only to ODs as the first tier of treatment. If we as a profession could mandate that by working with insurance companies or making it into law it would strengthen this profession immensely by being the referral gatekeepers. As it is now, a person with an eye issue may never see an OD.
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Regardless of what copay a patient shells out, ODs are not specialists. Again, taking reality and forcing it into the mold of your choice will not change anything. Optometry has no defined specialties. BC is not even tied to individual areas within optometry; it's broad based testing. It's a farce that's designed to increase revenue for the ABO. If you want to believe otherwise because it makes you feel all warm & fuzzy inside, that's your choice, but it's exactly what the AOA/ABO wants you to think.
Yeah.. Jason pretty much has it spot on here, which makes a lot of sense seeing as he's a practicing optometrist with knowledge of what's going on.
Optometrists are 'specialists' in the idea that they work with the eye. However, saying that optometrists are specialists further than that is just ignorant of the field. If you want to compare it to medicine, which people tend to do, here's my take:
We already take our NBEO tests in school, and those are our boards. Med school has similar tests in school, then after a residency they take another test so they can call themselves specialists in that field. We are already 'specialized' in the eye, so why should we be forced to take that same general test over and over, year after year? It doesn't make sense.
Some argue that it is a continually evolving/changing/growing (in terms of information, treatment), so we should have to be tested on competency.. but that's what CE is for, and that's something that works and is mandated!
As Jason said, the majority of optometrists will agree that it is a ruse to increase revenue for a group in the field.
I think that optometrists might change their views on the test if optometry had specializations and the BC tests were designed for these specializations, but there are none and the test is a general test similar to NBEO-1.. It's pointless and costly.
/rant
Optometrists are 'specialists' in the idea that they work with the eye. However, saying that optometrists are specialists further than that is just ignorant of the field. If you want to compare it to medicine, which people tend to do, here's my take:
We already take our NBEO tests in school, and those are our boards. Med school has similar tests in school, then after a residency they take another test so they can call themselves specialists in that field. We are already 'specialized' in the eye, so why should we be forced to take that same general test over and over, year after year? It doesn't make sense.
Some argue that it is a continually evolving/changing/growing (in terms of information, treatment), so we should have to be tested on competency.. but that's what CE is for, and that's something that works and is mandated!
As Jason said, the majority of optometrists will agree that it is a ruse to increase revenue for a group in the field.
I think that optometrists might change their views on the test if optometry had specializations and the BC tests were designed for these specializations, but there are none and the test is a general test similar to NBEO-1.. It's pointless and costly.
/rant
Isn't Vision Therapy a specialization? I haven't researched this at all, but I assumed there was extra years of schooling/residency to be an accredited Vision Therapist. Anyone know the requirements?
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Optometry doesn't have specialties like you find in medicine, dentistry, veterinary, etc. It has "residencies," but they do not culminate in the ability to practice in a defined specialty. I don't even know why we call them "residencies" because there isn't a single OD post grad program that really qualifies as such. You might be able to call it a fellowship, but even that doesn't make sense. It's basically expanded experience in a concentrated area. I think that's actually what they should call optometric residencies so that confusion is avoided. People should ask "So, are you going to gain expanded experience in ocular disease, contacts, primary care, pediatric optometry, etc?" The residency thing has always puzzled me.
Vision therapy is an area that a handful of OD practices concentrate in, but they do not and cannot "specialize" in it. In every state in the US, ODs are forbidden from using the terms "specialty," "specializing," "specialist," etc. We can say "practice limited to....." but nothing about specialization. In any event, it's doesn't make much difference because even ODs who have practices that "specialize" in certain areas like VT, do not specialize. One of the largest VT practices in the US is located in CA and he still advertises comprehensive eye care for all ages as the first thing on the list if you visit his website. It's just not practical for an OD to limit his practice - we need every patient we can get. For this reason and a host of others, optometry really can't exist as a profession with specialties. At least not in its current state. There's just no way it can happen. It's like trying to make a movie with Kevin Cosner that doesn't completely blow due to his inability to act and his total inability to do any sort of fake accent that is even remotely believable.
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Kevin Costner is the same person in every movie: the stoic, quiet hero. He has a good screen presence (I guess), but he's the same f****** guy in every movie. Waterworld, The Postman, Dances With Wolves.. etc. What a dullard.
I thought he was mediocre in JFK too. Speaking of which, JOE PESCI was AWFUL in JFK. He's another guy who plays one character. In JFK he (unskillfully) tried to employ this southern latino accent for parts, but then later in the movie he got angry and sounded exactly like his characters from Goodfellas and Casino - it didn't make any sense!
/rant
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It was like nails on a chalkboard.
What about how some Vision Therapists have "F.C.O.V.D" isn't that a higher level up?
"COVD offers optometrists and vision therapists the opportunity to become certified in vision development and vision therapy. The Board certification process is administered by the International Examination and Certification Board (IECB)."
are you saying being Board certified is some kind of scam? Can OD's still practice Vision Therapy without being Board certified?
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Yes, just like podiatrists and general dentists don't really give a f about their board certification, many ODs don't. Jason K just loves writing essays/ranting on SDN.
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Shnurek, when you don't understand something, it's best not to offer advice to someone who is seeking answers. Podiatric and dental specialties have virtually nothing in common with optometry and its areas of concentration.
janedoe88 said:
FCOVD is a fellowship status that can be attained by an OD, just like fellowship with the American Academy of Optometry. It does not allow you to practice at any different level than any other OD, it is simply a mark of achievement. Fellowship status is relatively easy to get. Getting Diplomate status in an area of optometry involves a lot more work, but is generally not recognized by the public. To answer your question, though, any OD can do VT. You absolutely do not need an FCOVD after your name to do it. Optometry is not like medicine or dentistry in which you can specialize and then obtain BC/fellowship status within a particular specialty. We can't specialize - that's the law talking, not me. We can concentrate, but not specialize. Like I've said before, though, there really is no way to truly specialize as an OD. It just can't work financially.
Okay I had to leave for a while due to family issues. And frankly had planned to forget about this website but I do enjoy viewing other professional forums and learning from them ( I enjoy the radiology area and would have loved to enter that field).
But then I peeked into this topic. The reason ODs can not specialize is very simple. LEGAL and FINANCIAL.
Allow me to explain.
Financial first: As Jason (and maybe others) have said, there is no way in heck an OD can limit his practice to just fitting contact lenses . 40 years ago this was possible due to the fact that CLs were new and actually difficult to fit. Paul Farkas,OD webmaster on ODwire.org had a specialty only CL practice in NYC for many years and did well I understand. Other ODs gladly referred patients to him as he had no optical an did no routine exam. He has long since retired but his practice is still there with other docs. But guess what, it's no longer a CL speciality practice. They do everything there now and of course, have an optical. Why? Had to. The 2 people per month that need an upper-level contact lens specialist just don't pay the bills to keep a pratice open.
Any OD (or probably optican or tech for that matter) can fit a contact lens nowadays on 99.5% of the population. They are idiot-proof for the most part.
The second reason ODs will never become specialists in a particular area of the eye (and I'm surprised no one has brought this up) is lawyers. Think about it. Say I decide to limit my practice to glaucoma only. No optical. No routine eye exams. I just put out a sign and say my "practice is limited to glaucoma' and I market this. This is perfectly legal. I'd get some self-referring pts that saw my ad and come in for their glaucoma treatment. BUT a speciality untimately relies on referrals from colleagues. (This is why OMDs court ODs for cataract and Lasik referrals).
So there I am with my glaucoma practice (which I am fully licensed to diagnose and treat (topically only). One day an area OD has a patient that he thinks might have narrow angles making him a glaucoma suspect so he sends him to my speciality 'glaucoma-only' practice for a consult. I see him, do the testing, agree on the narrow angles, educate the patient and believe he is fine to monitor routinely and send the pt back to the referring OD (this is what a glaucoma OMD usually does unless they are an ass or maybe does a prophylactic PI first).
Follow me here------- 6 months later the patient has an angle closure glaucoma crisis--but he's in Ghana on a mission trip and doesn't receive treatment quickly. He ultimately loses sight in that eye. He's now blind and decides to sue.
Both ODs (me and the referring one) go to trial along with a few OMD fellowship trained glaucoma specialists. The first question that the referring OD gets from the attorney is: "Dr. *******, why on earth would you send a patient with a potential blinding eye condition to another optometrist, that is not trained or licensed to surgically treat my client's condition so that he does not have a angle closure resulting in blindness. (even thought a prophylactic laser peripheral iridotomy is many times optional). Why send him to another optometrist when there were at least 2 outstanding fellowship-trained glaucoma ophthalmologists surgeons in the area that my client could have seen who would have absolutely prevented this terrible tragedy with a simple 30 second laser procedure? BOOOM!! $5,000,000 judgement!!
Picture the same with an OD "specializing in "Retina" or cornea problems. A referring OD has a patient with flashes and floaters but despite a dilated retinal exam with scleral indentation, just can't see a retinal tear. Now would it be wise for the OD to send this patient to another OD that 'specializes" in the retina OR send him to a fellow-shipped trained vitreo-retinal OMD surgeon down the street? Who would you feel more comfortable referring to to keep the lawers off your ass? Better question, who would YOU want to be referred to if you were the patient?
ODs are simply not top of the totem pole on ANY medical or surgical eye condition. That's why we can't specialize in any particular medical area. We can specialize in a VISION area like vision therapy where we can't blind people. But because 99% of the world thinks VT is voodoo, that road is all uphill.
P,S, I earned my status as a fellow of the American Academy of Optometry. It consisted of written case reports and an oral defense of the cases. But my FAAO status which I guess looks good on my letterhead, gives me absolutely no higher status to the public or my fellow professionals. It gives me no special ablities or authority that any other OD doesn't have. It's not very hard to get. Military ODs like to do it to help with gaining rank. Pretty much the same with FCVOD (Fellow College of Optometrist in Vision Development). There are a few hoops to jump through to get her FCVOD and you can post it on your sign and website. It might make a few ODs refer some 'googely' eyed kids to you but if you ask VT ODs (if you can find one), they get VERY few general OD referrals. Unfortuantely many of them come across as the mad scientist type having pts jump on one leg while reading letters off of a swinging tennis ball.
So in summary: You will not be able to specialize in optometry in the way an OMD does, meaning limiting your practice to just one thing. You can emphasize what you do in your primary care OD practice (like peds or VF or low vision) but most of that will be charity work. You will pay the bills with the ole', "Which is better, One or Two"..
This is the truth, the whole truth and nothing but the truth.
But then I peeked into this topic. The reason ODs can not specialize is very simple. LEGAL and FINANCIAL.
Allow me to explain.
Financial first: As Jason (and maybe others) have said, there is no way in heck an OD can limit his practice to just fitting contact lenses . 40 years ago this was possible due to the fact that CLs were new and actually difficult to fit. Paul Farkas,OD webmaster on ODwire.org had a specialty only CL practice in NYC for many years and did well I understand. Other ODs gladly referred patients to him as he had no optical an did no routine exam. He has long since retired but his practice is still there with other docs. But guess what, it's no longer a CL speciality practice. They do everything there now and of course, have an optical. Why? Had to. The 2 people per month that need an upper-level contact lens specialist just don't pay the bills to keep a pratice open.
Any OD (or probably optican or tech for that matter) can fit a contact lens nowadays on 99.5% of the population. They are idiot-proof for the most part.
The second reason ODs will never become specialists in a particular area of the eye (and I'm surprised no one has brought this up) is lawyers. Think about it. Say I decide to limit my practice to glaucoma only. No optical. No routine eye exams. I just put out a sign and say my "practice is limited to glaucoma' and I market this. This is perfectly legal. I'd get some self-referring pts that saw my ad and come in for their glaucoma treatment. BUT a speciality untimately relies on referrals from colleagues. (This is why OMDs court ODs for cataract and Lasik referrals).
So there I am with my glaucoma practice (which I am fully licensed to diagnose and treat (topically only). One day an area OD has a patient that he thinks might have narrow angles making him a glaucoma suspect so he sends him to my speciality 'glaucoma-only' practice for a consult. I see him, do the testing, agree on the narrow angles, educate the patient and believe he is fine to monitor routinely and send the pt back to the referring OD (this is what a glaucoma OMD usually does unless they are an ass or maybe does a prophylactic PI first).
Follow me here------- 6 months later the patient has an angle closure glaucoma crisis--but he's in Ghana on a mission trip and doesn't receive treatment quickly. He ultimately loses sight in that eye. He's now blind and decides to sue.
Both ODs (me and the referring one) go to trial along with a few OMD fellowship trained glaucoma specialists. The first question that the referring OD gets from the attorney is: "Dr. *******, why on earth would you send a patient with a potential blinding eye condition to another optometrist, that is not trained or licensed to surgically treat my client's condition so that he does not have a angle closure resulting in blindness. (even thought a prophylactic laser peripheral iridotomy is many times optional). Why send him to another optometrist when there were at least 2 outstanding fellowship-trained glaucoma ophthalmologists surgeons in the area that my client could have seen who would have absolutely prevented this terrible tragedy with a simple 30 second laser procedure? BOOOM!! $5,000,000 judgement!!
Picture the same with an OD "specializing in "Retina" or cornea problems. A referring OD has a patient with flashes and floaters but despite a dilated retinal exam with scleral indentation, just can't see a retinal tear. Now would it be wise for the OD to send this patient to another OD that 'specializes" in the retina OR send him to a fellow-shipped trained vitreo-retinal OMD surgeon down the street? Who would you feel more comfortable referring to to keep the lawers off your ass? Better question, who would YOU want to be referred to if you were the patient?
ODs are simply not top of the totem pole on ANY medical or surgical eye condition. That's why we can't specialize in any particular medical area. We can specialize in a VISION area like vision therapy where we can't blind people. But because 99% of the world thinks VT is voodoo, that road is all uphill.
P,S, I earned my status as a fellow of the American Academy of Optometry. It consisted of written case reports and an oral defense of the cases. But my FAAO status which I guess looks good on my letterhead, gives me absolutely no higher status to the public or my fellow professionals. It gives me no special ablities or authority that any other OD doesn't have. It's not very hard to get. Military ODs like to do it to help with gaining rank. Pretty much the same with FCVOD (Fellow College of Optometrist in Vision Development). There are a few hoops to jump through to get her FCVOD and you can post it on your sign and website. It might make a few ODs refer some 'googely' eyed kids to you but if you ask VT ODs (if you can find one), they get VERY few general OD referrals. Unfortuantely many of them come across as the mad scientist type having pts jump on one leg while reading letters off of a swinging tennis ball.
So in summary: You will not be able to specialize in optometry in the way an OMD does, meaning limiting your practice to just one thing. You can emphasize what you do in your primary care OD practice (like peds or VF or low vision) but most of that will be charity work. You will pay the bills with the ole', "Which is better, One or Two"..
This is the truth, the whole truth and nothing but the truth.
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O hey look, another doom and gloom poster on the radiology forums. A field you would have loved to enter.
See a trend here? People come online to bitch anonymously about their lives. (I make 100k a year but I'm not happy wahhh wahhhh) As Arnold Schwarzenegger says:[YOUTUBE]http://www.youtube.com/watch?v=WL1lfSzgcAw[/YOUTUBE]
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Shnurek, you must be an Obummer-supporting liberal because you show all the traits of someone out of touch with reality. This thread has nothing to do with radiology, the Governator, knitting, basket weaving, or anything else, for that matter. It has to do with the AOS/ABO legal battle.
For what it's worth, please refrain from handing out criticisms to people complaining about their income until you've actually had to support at least one person on your own. When you live at home and mommy and daddy wipe your bum for you, you really aren't in a place to make those sorts of judgements.
For what it's worth, please refrain from handing out criticisms to people complaining about their income until you've actually had to support at least one person on your own. When you live at home and mommy and daddy wipe your bum for you, you really aren't in a place to make those sorts of judgements.
I don't know much about this because I am not an optometrist...but it seems awfully hard to believe that so many practicing ODs would come on here and say things without merit. If it was one person whatever..but there are not.
As for the practicing in rural whereever after growing up in NYC, it can be done but the data shows that most people end up practicing where they grew up or trained. Just like a glaucoma specialist who I am friends with go an offer fora job in Lubbock Tx for $450K and he turned it down because the money just wasn't worth being in...Lubbock Texas..
Just some thoughts from an outsider.
As for the practicing in rural whereever after growing up in NYC, it can be done but the data shows that most people end up practicing where they grew up or trained. Just like a glaucoma specialist who I am friends with go an offer fora job in Lubbock Tx for $450K and he turned it down because the money just wasn't worth being in...Lubbock Texas..
Just some thoughts from an outsider.
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Statistically it is true. However, I'm sure you've heard of many people that just want to go to a "big city" because they grew up and spent most of their lives in a small town. On my end its the opposite. Having grew up here in new scum city. I want to go to a small town. To each their own I guess. A lot of my fellow classmates plan to go elsewhere as well. They come here for 2-3 months and they are like, "what the hell, everything is so expensive and its dirty here." I'm like, yup
BTW Jason K, i'm not a badbama supporter.
Okay I had to leave for a while due to family issues. And frankly had planned to forget about this website but I do enjoy viewing other professional forums and learning from them ( I enjoy the radiology area and would have loved to enter that field).
But then I peeked into this topic. The reason ODs can not specialize is very simple. LEGAL and FINANCIAL.
Allow me to explain.
Financial first: As Jason (and maybe others) have said, there is no way in heck an OD can limit his practice to just fitting contact lenses . 40 years ago this was possible due to the fact that CLs were new and actually difficult to fit. Paul Farkas,OD webmaster on ODwire.org had a specialty only CL practice in NYC for many years and did well I understand. Other ODs gladly referred patients to him as he had no optical an did no routine exam. He has long since retired but his practice is still there with other docs. But guess what, it's no longer a CL speciality practice. They do everything there now and of course, have an optical. Why? Had to. The 2 people per month that need an upper-level contact lens specialist just don't pay the bills to keep a pratice open.
Any OD (or probably optican or tech for that matter) can fit a contact lens nowadays on 99.5% of the population. They are idiot-proof for the most part.
The second reason ODs will never become specialists in a particular area of the eye (and I'm surprised no one has brought this up) is lawyers. Think about it. Say I decide to limit my practice to glaucoma only. No optical. No routine eye exams. I just put out a sign and say my "practice is limited to glaucoma' and I market this. This is perfectly legal. I'd get some self-referring pts that saw my ad and come in for their glaucoma treatment. BUT a speciality untimately relies on referrals from colleagues. (This is why OMDs court ODs for cataract and Lasik referrals).
So there I am with my glaucoma practice (which I am fully licensed to diagnose and treat (topically only). One day an area OD has a patient that he thinks might have narrow angles making him a glaucoma suspect so he sends him to my speciality 'glaucoma-only' practice for a consult. I see him, do the testing, agree on the narrow angles, educate the patient and believe he is fine to monitor routinely and send the pt back to the referring OD (this is what a glaucoma OMD usually does unless they are an ass or maybe does a prophylactic PI first).
Follow me here------- 6 months later the patient has an angle closure glaucoma crisis--but he's in Ghana on a mission trip and doesn't receive treatment quickly. He ultimately loses sight in that eye. He's now blind and decides to sue.
Both ODs (me and the referring one) go to trial along with a few OMD fellowship trained glaucoma specialists. The first question that the referring OD gets from the attorney is: "Dr. *******, why on earth would you send a patient with a potential blinding eye condition to another optometrist, that is not trained or licensed to surgically treat my client's condition so that he does not have a angle closure resulting in blindness. (even thought a prophylactic laser peripheral iridotomy is many times optional). Why send him to another optometrist when there were at least 2 outstanding fellowship-trained glaucoma ophthalmologists surgeons in the area that my client could have seen who would have absolutely prevented this terrible tragedy with a simple 30 second laser procedure? BOOOM!! $5,000,000 judgement!!
Picture the same with an OD "specializing in "Retina" or cornea problems. A referring OD has a patient with flashes and floaters but despite a dilated retinal exam with scleral indentation, just can't see a retinal tear. Now would it be wise for the OD to send this patient to another OD that 'specializes" in the retina OR send him to a fellow-shipped trained vitreo-retinal OMD surgeon down the street? Who would you feel more comfortable referring to to keep the lawers off your ass? Better question, who would YOU want to be referred to if you were the patient?
ODs are simply not top of the totem pole on ANY medical or surgical eye condition. That's why we can't specialize in any particular medical area. We can specialize in a VISION area like vision therapy where we can't blind people. But because 99% of the world thinks VT is voodoo, that road is all uphill.
P,S, I earned my status as a fellow of the American Academy of Optometry. It consisted of written case reports and an oral defense of the cases. But my FAAO status which I guess looks good on my letterhead, gives me absolutely no higher status to the public or my fellow professionals. It gives me no special ablities or authority that any other OD doesn't have. It's not very hard to get. Military ODs like to do it to help with gaining rank. Pretty much the same with FCVOD (Fellow College of Optometrist in Vision Development). There are a few hoops to jump through to get her FCVOD and you can post it on your sign and website. It might make a few ODs refer some 'googely' eyed kids to you but if you ask VT ODs (if you can find one), they get VERY few general OD referrals. Unfortuantely many of them come across as the mad scientist type having pts jump on one leg while reading letters off of a swinging tennis ball.
So in summary: You will not be able to specialize in optometry in the way an OMD does, meaning limiting your practice to just one thing. You can emphasize what you do in your primary care OD practice (like peds or VF or low vision) but most of that will be charity work. You will pay the bills with the ole', "Which is better, One or Two"..
This is the truth, the whole truth and nothing but the truth.
I'll start off by saying I interned for a Vision Therapist and he made at least 200k a year so I'm a bit biased, but I understand that he started his practice "back in the day" so it's not likely any of us new grads could get to his level of income (or anywhere near that number.)
Vision Therapy is actually getting a lot more credit with the evidence that it DOES improve vision. See the website http://www.covd.org for their research papers. The VT had referals from many other ODs/schools/Optomo/hospitals..etc. He pretty much did JUST Vision Therapy, besides prescribing glasses to his patients that were already coming in for VT. Also, he was very respected in his field and I don't think anyone would call him a "mad scientist" or his practices "voodoo." That sounds to be your OWN opinion on the matter.
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This seemingly minor detail is the core reason for my being on this site. There are some ODs who are doing well out there, but the vast majority of the "million dollar" OD practices out there were started in 80s or earlier. New grads face an entirely different set of "rules" and those differences will prevent new offices from developing into the large, high-momentum OD practices out there today.
I'm skeptical as to whether or not he does JUST vision therapy. If he's prescribing glasses, he's probably got an optical. If he's doing comprehensive exams on anyone, he's not just doing VT. Every "VT only" practice I've ever heard of (and there aren't many), did comprehensive eye exams, glasses, VT, binocular vision assessments, and in some cases, full scope primary eye care. Unless you're in a huge, entrenched VT practice, the money will just not be there to support the office. Sorry, but that's reality and it's not just Tippytoe or me saying that. Most ODs out there in private practice have at least thought about jumping onto the VT train at one time or another, but the money just isn't there.
As for the effects, I've seen great results with convergence insufficiency patients, but beyond that, I haven't seen much in the way of objective results. Many studies and tests I've looked at are horribly flawed, particularly those that deal with visual-spatial defects. If you give a kid a diagnostic test looking for visual-spatial disorders, then provide vision therapy, and then test progress by using the exact same test items used during the diagnostic evaluation, you're going to see improvement, even if there is no true treatment effect. In my experience, the diagnostic evals work somewhat well when administered by competent examiners, but the treatment just doesn't seem to do much. Maybe it's different in some places. When I was in school, the VT clinic was pretty much a way for parents to dump their PIA kids on someone for an hour while they went to the mall.
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He's been doing VT for over 30 years so he has a reputation as "The best in CA" so that's how he's able to do just VT. However, there is no way any new grad would be able to achieve the same status as he built over the years. There were a lot of patients with mental handicaps (I can see how their parents would "dump them for an hour"), but there were also a lot of normal children and children with ADHD or some other learning disability that were there for the actual vision therapy exercises.
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Dr Valenti (I'm pretty sure that's who you're talking about) has a "VT practice" like none other in the US so it's easy to look at an office like that and be wowed into thinking that it can be duplicated. All I'm saying is, don't go into optometry thinking that you'll get out and start up something like he's got going. Whether you see it or not, he has a primary care component to his practice - he does not just do VT and BV work. His office is no different from any other established, high volume, high revenue office that's owned by an OD who's over 50. If you love VT and want to do it after graduation, have at it. I'd even go as far as to say that you'll probably have an easier time finding a job if you're willing to move since hardly anyone wants anything to do with VT after they graduate. But just don't go into it thinking that you'll be able to duplicate what he's done - it just can't happen anymore. That's how people get deceived. They see what's out there right now and they think that's the optometry they're signing up for. It's not.
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how...how did you know that? lol yes I was speaking of Dr. Valenti as an example of someone who appears to have specialized. And I completely agree, I doubt anyone could achieve what he has done in the field.
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Okay moderators. I came back nice and sweet with a professional opinion on a post of interest, with absolutely no insults alluded, implied or expressed. And already Shnurek is back at it with absolutely no productive input whatsoever and nothing but insulting rhetoric.
WAIT?! IS Shnurek a moderator?
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And will you swear to everyone here that you personally saw a copy of his income tax forms to verify that his net personal income was "at least $200,000". Or are you just guessing a bit for dramatic effect? I'm not saying he didn't make that much. But do you really know?
Because I think many may have a misunderstanding. Even if you work for a doc you can't "deduce" what he makes just by counting up how many patients he sees per week and multiplying that by what he is billing. Just doesn't work that way.
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I'm not sure how we got on VT but here's my take on it (for what it's worth.....and I'm sure Shruck will be on later to tell me how it really is).
In school, it's the 'red-headed step-child' department. In Memphis, it was filled with a bunch of welfare kids who had a multitude of problems, the least of which was anything vision related.
The believers in Vision Therapy are, if nothing else, EXTREMELY arrogant. They seem to believe there are millions of people in society that have uncorrected (non-refractive) vision disorders that need to be corrected. Ask anyone at the AOA.
So to them (these VT believers), MILLIONS of previous and present optometrists and ophthalmologists have been too stupid to diagnose and/or treat all of these suffering (and mostly non-suffering) patients. AND ONLY THEY, THE GENIOUS VISION THERAPIST DOCTOR CAN SAVE THEM!!!.
Fact is, if you did all the silly binocular vision tests you will learn in school on every patient you see, probably 50% of them will fail at least one of them. Does that mean that need vision therapy?? If you run a VT clinic it does! If you bought an expensive hammer, you will find many nails.
But what if you have a person with 3 PhDs, and reads 18 novels a day but your tests diagnose convergence insufficiency and a mild amount of vertical prism. Think they want to pay you $3,000 for VT sessions?
So the only people that really succeed at VT, and I'm going to say it, are the slick infomercial guys that can sell ice to an eskimo. I think Vince from "Slap Chop" could do it. Helicopter moms that will do anything to make little Johnny get straight A's will be your primary patients so you must be in a wealthy area.
I appologize to any of you VT gurus in advance. This is how most of the profession of Optometry (and Ophthalmology) feels. Guess we are all idiots who have not seen the light yet.
In school, it's the 'red-headed step-child' department. In Memphis, it was filled with a bunch of welfare kids who had a multitude of problems, the least of which was anything vision related.
The believers in Vision Therapy are, if nothing else, EXTREMELY arrogant. They seem to believe there are millions of people in society that have uncorrected (non-refractive) vision disorders that need to be corrected. Ask anyone at the AOA.
So to them (these VT believers), MILLIONS of previous and present optometrists and ophthalmologists have been too stupid to diagnose and/or treat all of these suffering (and mostly non-suffering) patients. AND ONLY THEY, THE GENIOUS VISION THERAPIST DOCTOR CAN SAVE THEM!!!.
Fact is, if you did all the silly binocular vision tests you will learn in school on every patient you see, probably 50% of them will fail at least one of them. Does that mean that need vision therapy?? If you run a VT clinic it does! If you bought an expensive hammer, you will find many nails.
But what if you have a person with 3 PhDs, and reads 18 novels a day but your tests diagnose convergence insufficiency and a mild amount of vertical prism. Think they want to pay you $3,000 for VT sessions?
So the only people that really succeed at VT, and I'm going to say it, are the slick infomercial guys that can sell ice to an eskimo. I think Vince from "Slap Chop" could do it. Helicopter moms that will do anything to make little Johnny get straight A's will be your primary patients so you must be in a wealthy area.
I appologize to any of you VT gurus in advance. This is how most of the profession of Optometry (and Ophthalmology) feels. Guess we are all idiots who have not seen the light yet.
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Ortho K works fine, it just doesn't seem to be in demand as much as it was a few years ago, although that could just be in my area. What I've found, though, is that people tend to get it, use it for a year or so, and then say "Well, this is cool, but I'd rather be in my soft lenses so I'm just going back to that." It can pay well if you market it the right way and you can keep your fittings to a reasonable number of visits.
I know how much each patient pays (without insurance) and I know how many patients he has per day...it's easy math. The point is that he makes A LOT. And the fact that Jason K knew who I was talking about when all I said was "the best in CA"...probably shows how well-known his practice is to most people.
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Tippy Toe I agree with you. I think VT should only be used for evidence based treatment such as for convergence insufficiency. I don't really care for or want to care for VT and these annoying phoria tests piss me off because one second the patient is 2 prism diopters exophoric and in 5 seconds they are 2 prism diopters esophoric. Or when people do the modified thorington test on me with the maddox rod in. My freakin exophoria keeps growing. The red line isn't stable at one number.... So I'm like, "5 ok 7 ok 8 ok wait now its at 6." Sucks that SUNY is big on VT but w/e I'll deal with it.
I agree with Jason on Ortho-k (also known as CRT). I dabbled in it back in 2003. Had to buy a fitting set for $3,000 and I fit 3 'patients'-- two employees and my daughter. Ranging from - 1.00 sph to -4.00 sph. Actually ALL 3 were 20/20 within two days!
Awesome. I was very impressed (must use a corneal topographer). But even for free, two chose to go back to soft lenses and one opted for Lasik. Upon questioning, they stated if they are going to have to wear contact lenses, they might as well wear them during the day (as opposed to every night as in Ortho-K). (For those that don't know, they are basically like "braces" for the eyes--they flatten the cornea temporarily but return to normal if not worn at least every other night--usally every night--for ever.)
The 'killing' factor is usually the fitting fee and cost of lenses-- around $1,500. Most candidates will just opt for the one time (slightly higher) fee for Lasik.
The biggest market I suppose would be kids too young for refractive surgery. But with daily disposible soft lenses, I didn't get many kids parents that were interested in Ortho-K. Ultimately I sent the fitting set back for a refund before my 90 trail period ended.
So in summary: Ortho-K works. But most prefer other alternatives. And, once again, as with Vision Therapy and Low Vision, it's not that mosty ODs haven't tried to make money doing it. They have. Most probably have at some point or another. It's just that it's very difficult to do when insurance doesn't pay for any of them.
I think VT works on some occasions and some conditions. Many times it's simply giving the kid some much needed attention they are not getting at home. Other times it's simple repetitive vision tasks that make things a little better. Tracking and saccades necessary for reading are the most common visual tasks I see lacking in children having difficulty reading. They can't 'jump' from red pen to black pen held in front of them a few feet apart without overshooting or undershooting (or from the end of a sentence to the beginning of the next one below). Nothing that a few minutes of working on every day won't help in a week or two. Getting ghetto mom to get ghetto kid to do it is another story. Telling educated mom and showing her will usually get the job done as she will take care of it at home. Not really rocket science.
Where the Vision Therapist come in is having the patient come to the office a few times per week to work with them as we all know that patients do what we tell them about 20% of the time. All in all, not a bad thing. Maybe more in the realm of psychology perhaps.
Hey bounce a basketball everyday and you'll get pretty good at bouncing a basketball.
P.S. I had a mom come back and praise me for showing her that her kid couldn't track words very well when reading. I showed them how to do saccadic 'exercises' (games) at home and she came back the next year and told me it was the greatest thing she has ever done for her son and he is now reading 2 or 3 grade levels ahead. Placebo. Who knows? Either way, she fought the insurance bill for the routine exam (tricare) and it took me 5 months to get paid. True story.
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scumbags
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Better get used to it. People have no problem fighting tooth and nail to hold on to their money when it comes to paying the OD. Why should I pay for an eye exam when it's free at the box down the street and I get 14 pairs of progressive lenses free along with a 50 lb bag of fertilizer and 2000 ct pack of candycanes from last year's Christmas season?" If this stuff pisses you off.....you're in the wrong profession.
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Then is every OD in the wrong profession? I think this would piss anyone off. The ophthalmologist I worked for didn't get paid for 2 months when Medicare froze payments. She was sitting on the floor one day complaining she doesn't get paid enough. Healthcare is very political and not an easy job but I'll do what it takes. Or I'll join the military and get paid a salary.
Do you think people will be more inclined to use Ortho-K if they only have to wear it for one night per several days or even a week?
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You missed the point. My point was that patients, in many cases, do not feel the OD is "worthy" of their or their insurance's money. Tippytoe's example demonstrated that even if you "walk on water," you're going to have to deal with those types of patients. I bet you'd have a hard time finding a neurologist who says he/she had a wonderfully satisfied patient who fought a claim for a visit for 5 months. Many patients feel that, because they can go down the street to the nearest doc-in-the-box and get a "free" or nearly-free eye exam, they shouldn't have to pay.
And FWIW, yes.....there are MANY ODs out there who feel they are in the wrong profession.
