Can ODs Perform LASIK???

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This thread is insane. For the third time, I don't dislike PAs. I know very little about it. I only did the attack thing to show FuturePA what he was doing to us.

I have been saying from the start that ODs are not suppose to be Lasik surgeons, that is the ophth job, I just was not going to allow someone with NO knowledge of optometry to bash it.

Sorry for fueling the rampant fire.

JPNSU-
Sorry for not being "real.":laugh:
 
*Blushes*

Yeah, I guess I've been bratty too.

Eyegirl
 
Originally posted by rpames
For the third time, I don't dislike PAs. I know very little about it.
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Nice "Bushism"! Keep them coming.
 
.
sometimes this OD vs Opth.MD war or whatever you want to insert into them made me think we are no different than bunch of 8yrs old fighting for that candy bar.
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That's what I've been trying to say since post number......oh I dont' remember anymore!! 😉
 
wow, I think this is the first triple digit thread we've ever had in this forum!! 😱 😱
 
Originally posted by rpames
This thread is insane. For the third time, I don't dislike PAs. I know very little about it. I only did the attack thing to show FuturePA what he was doing to us.

I have been saying from the start that ODs are not suppose to be Lasik surgeons, that is the ophth job, I just was not going to allow someone with NO knowledge of optometry to bash it.

Sorry for fueling the rampant fire.

JPNSU-
Sorry for not being "real.":laugh:
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I was refering to your ridiculous claim of superior clinical skill? Give me a break🙄 Learn to live with the fact that you settled on becoming an optometrist...


Originally posted by rpames
One other factor which comes into play is the competition in getting on Ophthalmology residence. It's one of the most competitive to get. Being the top of your class does not even guarantee that you will get it. At this point in the game, the decision is really OD or MD/DO. You need to assume you will get an average residence. There are three careers I can see myself as; 1. OD, 2. OMD, 3. Orthopeadic Surgeon. 2 and 3 are the most competitive residencies to get, my odds are slim to get one of them. I know I will be happy being an OD and the lifestyle is very attractive. For those reasons, I choose to follow the OD route.
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I'll be sure to call upon your superior intellect for a curbside consult during my residency...this has been your best reply yet.
 
JPNSU-
Why are you jumping on my back? I have not said anything aggressive to you. My response to FuturePA was in response to him saying, ??smoke YOU?? That is directed directly at me. He knows nothing of my medical knowledge or intelligence, nor do you for that matter. Most of what I said about ?smoking? everyone was meant in sarcasm. As far as clinical knowledge, I?m only an undergrad right now, for my current limited formal medical education, I?m pretty knowledgeable. I can see how that could sound conceited, but I did not mean it that way. There is no way of anyone measuring how well I would compare to others in program, but I can guarantee you I would put in 10 times the effort, I always have.

Oh yea, as far as ?settling? on optometry, whatever. I noticed you go to DO school, I?m doing research at DMU and I speak to Profs and admissions people all the time. I have been told, in fact just this week, that I could be in medical school next year if I wanted it. I settle for nothing! Don?t attack me when you know nothing about me.

Spinola-
What is your problem? I stated many times that I have no problem with PA, even in my first post about them I put a disclaimer. I was posting about the limits of PAs (w/o much knowledge about them), just as he was posting about ODs (w/o much knowledge). I was attacking to show him what he was doing to me.
 
Originally posted by rpames
JPNSU-
Why are you jumping on my back? I have not said anything aggressive to you. My response to FuturePA was in response to him saying, ??smoke YOU?? That is directed directly at me. He knows nothing of my medical knowledge or intelligence, nor do you for that matter. Most of what I said about ?smoking?everyone was meant in sarcasm. As far as clinical knowledge, I?m only an undergrad right now, for my current limited formal medical education, I?m pretty knowledgeable. I can see how that could sound conceited, but I did not mean it that way. There is no way of anyone measuring how well I would compare to others in program, but I can guarantee you I would put in 10 times the effort, I always have.

Oh yea, as far as ?settling?on optometry, whatever. I noticed you go to DO school, I?m doing research at DMU and I speak to Profs and admissions people all the time. I have been told, in fact just this week, that I could be in medical school next year if I wanted it. I settle for nothing! Don?t attack me when you know nothing about me.

Spinola-
What is your problem? I stated many times that I have no problem with PA, even in my first post about them I put a disclaimer. I was posting about the limits of PAs (w/o much knowledge about them), just as he was posting about ODs (w/o much knowledge). I was attacking to show him what he was doing to me.
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you are still only in undergrad and you make such comments?? you have got to be kidding me?? are you serious???

fine get into med school, if you can ...talk is cheap...say whatever you want...talk to me after you matched into an ACGME approved ophthalmology or orthopedic surgery residency like you "aspire to."

I am only months away from finishing med school and have already matched into an ophtho residency and am not afraid to say that I am humbled every single day as to how much I don't know and still have to learn...but I guess you are ahead of the game🙄

you're right...I don't know much about you...I'd like to keep it that way
 
JPNSU.. please stop the personal attacks.. From what I can see.. rpames did nothing to provoke you. He apologized earlier for his outburst with futurepa and he's been a constructive member of this forum for a long time now.

If you can't say anything contructive in this forum without resorting to personal attacks against the users I'm going to have to ask you to leave.
 
Thanks CPW.

JPNSU-
I am actually a very humble person and I am reminded daily of my gaps in knowledge. But when someone makes comments infering that I am not capable of making it in medical school, I'm not going to take. I doubt would have 4 years ago either. As far as my "aspiration," I aspire to be the best at what ever I end up doing, OD, MD/DO, or lightbulb maker. I spoke of three jobs I would like to do, I do not aspire to be anyone of them over another. If I wanted to go to medical school I would go, and if I did not make it this year I would apply again next year, if I go to OD school and then decide it is not for me, I then will apply to medical school.

Although I have plenty I would like to say to you, I will not.

Now for a constructive question, how do you like Nova? Have you had any classes with the OD students? Do you share facilites at all?
 
Looks like someone is not going to let the "candy bar" go...

Lets try to push this thread to 200 posts, what do you say, moderator?
 
Hmmmm,

Well, I've been reading these posts for the past week or so. I now have time to respond. I have resisted for some time because I felt the converstion was borderline stupid.

It is painfully obvious that most of the folks posting here don't have a clue what they are talking about.

Some of the points have been well made.........most not.

I have a very successful private Optometry practice. I treat a wide range of ocular conditions from fitting eyeglasses and contact lenses to treating ocular disease. I have one of the largest glaucoma practices in my area and co-manage those cases needing surgery with our very fine sub-specialist Ophthalmologists. I have an excellent relationship with our local fellowship trained glaucoma Ophthalmologist who is called in whenever surgery is needed.

My unsolicited advice to any aspiring Ophthalmologists here. You will make your life much easier, make yourself much more money, and be generally much more successful working WITH OD's than against them. We have a few lonely Ophthalmologists (mostly older, poorly skilled) in the area that are so anti-Optometry that they actually have a sign in their waiting area describing OD's as "Non-Doctors who are only able to prescribe eyeglasses" ( a definition from 1930). In the 1980's a young Ophthalmologist came to town, talked with the local OD's and developed a great mutually benefical referral network. This Ophthalmology group now has 10 MD's and 4 OD's on staff and has grown into one of the largest in the state.

Meanwhile, the lonely arrogant Ophthalmologists (there are 2 now....1 has recently retired) are still struggling for primary care patients. One has lost his hospital privilages. I have a number of their mis-diagnosed patients including one last week with a congrous right quadrantopsia that was misdiagnosed as a glaucoma patient for the last 6 years (She obviously has had a stroke). She has 0.10/0.10 cupping, normal pressures, thick corneas on pachymetry, and normal Heidelberg Retinal Tomograpy (HRT). Unfortunately, she was made to spend $85/month for the last 6 years on 2 topical glaucoma meds that she didn't need. The visual field defects are classic for a past stoke localized in the temporal lobe. The worse part was that she never had a visual field.....not once. She was diagnosed with open angle glaucoma and treated by 2 different Ophthalmologists and never had a visual field performed. That is malpractice!

Of course, this scenerio happens with OD's as well. My point- it happens to both professions and you have very sorry people in both fields. These two Ophthalmologists are the worst of the worst that we have here. The other 12 are outstanding doctors.

I have 4 MD Internists and 6 PA's that refer to me on a weekly basis. Usually after they figure out that sulfacetamide doesn't cure everything they call a "red eye". It took me treating one case of idiopathic, unilateral, non-graulomatous, anterior uveitis in a 10 year old kid with incidental 0.80/0.80 cupping and high pressures, making him a glaucoma suspect, to convice them that I knew what I was doing.

By the way, I have PA students rotating through my office on a monthly basis to learn about eye care. I have a great deal of respect for the training of PA's. They, like the general MD, know virtually nothing about the eyes. But the ones that come through my office will.

My bottom line. You just don't get far being an ass. No matter how smart you are......or how smart you think you are, people can recognize an ass-hole from a mile away.

To the OD students and soon to be students. You have to make a choice. You can be a refractionist and work at Walmart or Lenscrafters or you can be an eye doctor (OD or OMD) but you can't do both. OD's next to commercial stores are the worst thing that has happened to our profession.

But above all, Be Nice. Unfortunately, there are plenty of sick eyes (and bodies) for as many people as we can train to treat them. It's not a competition. If your good........your good and remember "The people who truly deserve respect, don't have to demand it" 🙂
 
Originally posted by TomOD

But above all, Be Nice. Unfortunately, there are plenty of sick eyes (and bodies) for as many people as we can train to treat them. It's not a competition. If your good........your good and remember "The people who truly deserve respect, don't have to demand it" 🙂
Click to expand...


:clap: :clap: :clap:

I've missed you, Tom!!
Welcome back and well said!
 
You can always tell real class by the way they post, thanks Tom. You are truely someone we OD students (or to-be-OD students) should look up to.

By the way, I looked for the artical you wrote for Review and I must have missed it. What month was it in?
 
Optometric Management, Jan. 2003

Thanks
 
Tom OD
It is up to the individual on how he or she practices optometry. It's what you make of it. Not all ODs are just refractionists who work next to commercial stores. There are alot of optometrists who have excellent knowledge base, superior clinical skills and are very personable that do extremely well working the corporate mode. I believe it's unfair to make such a statement "its the worst thing that has happened to our profession." Are you talking about competency or the way our profession gets perceived?
 
Originally posted by TomOD
Hmmmm,

Well, I've been reading these posts for the past week or so. I now have time to respond. I have resisted for some time because I felt the converstion was borderline stupid.

It is painfully obvious that most of the folks posting here don't have a clue what they are talking about.

Some of the points have been well made.........most not.

I have a very successful private Optometry practice. I treat a wide range of ocular conditions from fitting eyeglasses and contact lenses to treating ocular disease. I have one of the largest glaucoma practices in my area and co-manage those cases needing surgery with our very fine sub-specialist Ophthalmologists. I have an excellent relationship with our local fellowship trained glaucoma Ophthalmologist who is called in whenever surgery is needed.

My unsolicited advice to any aspiring Ophthalmologists here. You will make your life much easier, make yourself much more money, and be generally much more successful working WITH OD's than against them. We have a few lonely Ophthalmologists (mostly older, poorly skilled) in the area that are so anti-Optometry that they actually have a sign in their waiting area describing OD's as "Non-Doctors who are only able to prescribe eyeglasses" ( a definition from 1930). In the 1980's a young Ophthalmologist came to town, talked with the local OD's and developed a great mutually benefical referral network. This Ophthalmology group now has 10 MD's and 4 OD's on staff and has grown into one of the largest in the state.

Meanwhile, the lonely arrogant Ophthalmologists (there are 2 now....1 has recently retired) are still struggling for primary care patients. One has lost his hospital privilages. I have a number of their mis-diagnosed patients including one last week with a congrous right quadrantopsia that was misdiagnosed as a glaucoma patient for the last 6 years (She obviously has had a stroke). She has 0.10/0.10 cupping, normal pressures, thick corneas on pachymetry, and normal Heidelberg Retinal Tomograpy (HRT). Unfortunately, she was made to spend $85/month for the last 6 years on 2 topical glaucoma meds that she didn't need. The visual field defects are classic for a past stoke localized in the temporal lobe. The worse part was that she never had a visual field.....not once. She was diagnosed with open angle glaucoma and treated by 2 different Ophthalmologists and never had a visual field performed. That is malpractice!

Of course, this scenerio happens with OD's as well. My point- it happens to both professions and you have very sorry people in both fields. These two Ophthalmologists are the worst of the worst that we have here. The other 12 are outstanding doctors.

I have 4 MD Internists and 6 PA's that refer to me on a weekly basis. Usually after they figure out that sulfacetamide doesn't cure everything they call a "red eye". It took me treating one case of idiopathic, unilateral, non-graulomatous, anterior uveitis in a 10 year old kid with incidental 0.80/0.80 cupping and high pressures, making him a glaucoma suspect, to convice them that I knew what I was doing.

By the way, I have PA students rotating through my office on a monthly basis to learn about eye care. I have a great deal of respect for the training of PA's. They, like the general MD, know virtually nothing about the eyes. But the ones that come through my office will.

My bottom line. You just don't get far being an ass. No matter how smart you are......or how smart you think you are, people can recognize an ass-hole from a mile away.

To the OD students and soon to be students. You have to make a choice. You can be a refractionist and work at Walmart or Lenscrafters or you can be an eye doctor (OD or OMD) but you can't do both. OD's next to commercial stores are the worst thing that has happened to our profession.

But above all, Be Nice. Unfortunately, there are plenty of sick eyes (and bodies) for as many people as we can train to treat them. It's not a competition. If your good........your good and remember "The people who truly deserve respect, don't have to demand it" 🙂
Click to expand...


I have no problems with working with ODs in the future. I agree the issue goes both ways. I do have a problem with some ODs who continue to lobby and push for rights to perform surgery no matter how minor they make it out to be. This very act is just as bad as the example you gave of the commercial OD setting up shop in Walmart. They do nothing but denigrate your profession and make the general masses ignorant of what type of service you provide. The bottom line is know your role and stick to it.
 
Great article Tom ! It makes me excited to get out and start practicing. I hope I can be as ambitious when I'm out there. I'll definitely know who to write to for advice. 😉
 
Originally posted by Reality check
Tom OD
It is up to the individual on how he or she practices optometry. It's what you make of it. Not all ODs are just refractionists who work next to commercial stores. There are alot of optometrists who have excellent knowledge base, superior clinical skills and are very personable that do extremely well working the corporate mode. I believe it's unfair to make such a statement "its the worst thing that has happened to our profession." Are you talking about competency or the way our profession gets perceived?
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I found that the OD I used to go to next to a Lenscrafters had MUCH better clinical skills and much more knowledge than the OD in private practice that I see now. Of course, exceptions can always be found. I'm sure he was speaking more in a general sense.
 
Originally posted by TomOD


To the OD students and soon to be students. You have to make a choice. You can be a refractionist and work at Walmart or Lenscrafters or you can be an eye doctor (OD or OMD) but you can't do both. OD's next to commercial stores are the worst thing that has happened to our profession.
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Tom,

America has the most commercialised healthcare system in the world, and yet you still have the gall to denigrate those of your peers who work at Walmart and Lenscrafters. I would argue that such companies benefit the health of the community by providing affordable eye-care in a system that is essentially inegalitarian.

Your attack on optometrists working for Walmart and Lenscrafters is just as unmerited as rprames' and others' attacks on PAs. I strongly suggest that you practice what you preach.
 
Originally posted by cpw
oh goody.. another DO vs MD vs OD debate.. my favorite.. 🙄
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OMG exactly! please people
 
TomOD, I agree with you completely. By the way, great article.


Spinola-I'd just like to say again that I only attacked the PA profession in response to the attacks on ODs. Even if my attack was unmeritted, I think you should have mentioned FuturePA's attacks on ODs.😀

Affordable eye-care? I don't think so. How is it affordable when theses one hour shops rip you off on glasses. Sure, their exams maybe cheaper, but so is the quality. When ever we receive a transfer record from one of those chains, it is pathetic! It has little more than the patient's Rx on it. There is close to no recorded pathology or ocular health information. Then when they go to sell you glasses they way over charge you for the materials. They may offer that pair for $39.00, but few people ever get out of the store with that. That frame probable cost them $5.00 at most. If you go to pick out a good frame the mark up is outrageous! If you were to get the SAME frame at most private offices, you would pay much less! I have seen this many many times. So often I'll show patients frame ranging from $59.00 to $250.00, I'll tell them the prices and they more often than not pick the $150+ frame. Then I'll show them the lens options. I'll tell them about the plane lens with no extras and then tell them about the anti-reflecting and scratch coats, the no-line progressive bifocals, the extra thin lenses, the transions tints, ect. More often than not they get at least one of the extras. They then walk out with a $250+ pair of glasses. They could have left for less than $100, but they don't. When they hear the price they'll say, "But Wal-mart says I can get glassess and lenses for X dollars." I'll respond, "Yes you can, but this is what you will get......." Their responce is the same, "Well, I don't want that." Then they leave with a smile knowing that if something is wrong with those glasses they can come back and say, "Ryan, this is wrong." I'll reply, "You are right, and this is what I'll do." Or if I can't fix it, my father, the main optician, and the office manager are within shouting distance and they will make it work.

Large corparate medicine is not worth it, if something goes wrong, they can always dismis you by saying, "well, this is corporte policy and I can't help you." In private and small group practices, "corporate" is in the next room doing an eye-exam. You get what you pay for, in quality of product and medically.
 
Originally posted by rpames
TomOD, I agree with you completely. By the way, great article.


Spinola-I'd just like to say again that I only attacked the PA profession in response to the attacks on ODs. Even if my attack was unmeritted, I think you should have mentioned FuturePA's attacks on ODs.😀

Affordable eye-care? I don't think so. How is it affordable when theses one hour shops rip you off on glasses. Sure, their exams maybe cheaper, but so is the quality. When ever we receive a transfer record from one of those chains, it is pathetic! It has little more than the patient's Rx on it. There is close to no recorded pathology or ocular health information. Then when they go to sell you glasses they way over charge you for the materials. They may offer that pair for $39.00, but few people ever get out of the store with that. That frame probable cost them $5.00 at most. If you go to pick out a good frame the mark up is outrageous! If you were to get the SAME frame at most private offices, you would pay much less! I have seen this many many times. So often I'll show patients frame ranging from $59.00 to $250.00, I'll tell them the prices and they more often than not pick the $150+ frame. Then I'll show them the lens options. I'll tell them about the plane lens with no extras and then tell them about the anti-reflecting and scratch coats, the no-line progressive bifocals, the extra thin lenses, the transions tints, ect. More often than not they get at least one of the extras. They then walk out with a $250+ pair of glasses. They could have left for less than $100, but they don't. When they hear the price they'll say, "But Wal-mart says I can get glassess and lenses for X dollars." I'll respond, "Yes you can, but this is what you will get......." Their responce is the same, "Well, I don't want that." Then they leave with a smile knowing that if something is wrong with those glasses they can come back and say, "Ryan, this is wrong." I'll reply, "You are right, and this is what I'll do." Or if I can't fix it, my father, the main optician, and the office manager are within shouting distance and they will make it work.

Large corparate medicine is not worth it, if something goes wrong, they can always dismis you by saying, "well, this is corporte policy and I can't help you." In private and small group practices, "corporate" is in the next room doing an eye-exam. You get what you pay for, in quality of product and medically.
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So your excuse is: "they started it". Most puerile.

Your previous argument ran that optometry is a primary care profession. I think you'll have to admit that the companies you abhor provide affordable primary eye-care. Or have you changed tack and decided that optometry's main service to the public is in the provision of spectacles? As regards record keeping, I doubt that your observations make for a valid comparison.
 
It's been interesting watching this thread develop and the most recent turn of events have shown why I've decided against going into Optometry. Certain posters have complained about being attacked by some of the MD students, yet they feel compelled to attack other members of their profession. Like it or not, corporate optometry is here to stay folks. By attacking other members of your profession, it makes the yourself, and those who do so, look unprofessional. BTW, it should be noted that most people who graduate from optometry school follow that route. (One of the doctors who works in my office graduated last year. She told me that most of her classmates are working in commercial practices. I've heard this from other optometrists as well.)

As for the competency of the optometrists, I find your claims that most of the records contain little to no pathology information VERY inaccurate. I've worked in the field for 4 years and having seen many examination cards from different offices and I have never seen a record which did not contain a health evaluation, (i.e., CD's, muscle balance, retinal eval, etc.)

On the subject of overcharging for materials, I take it that you only charge at cost for materials at your father's office. There is a business aspect to Optometry and one would think that private offices are more concerned with the commercial aspect because they are the people who own the dispensary. If there is an instance where a patient has a problem with their glasses, the doctor ALWAYS double checks the RX, free of charge. If the RX is correct, then the optician adjusts the frame and works with the patient until the problem is resolved. I have never heard an optician say to a patient, "Well, this is corporate policy and I can't help you." Total fabrication there.

Bottom line, if you are going to attack the corporate optometry, it's important to be accurate with the facts you use to defend your position. Most of the threads on this board contain intelligent responses and are accurate. However, this thread has turned ugly and most of the responses have been defensive and horribly inaccurate. Hopefully, this thread can return to the positive tone to which it was originally intended.

Nick
 
PLEASE let's not turn this now into a commerical vs private practice thing! Then, we're just turning against ourselves and that does make us look unprofessional.

I thought we were going to return to normalcy... we had some great posts.. and then it just turned ugly again. This is getting ridiculous and I'm getting quite sick of it.

+pissed+ 😡 🙄
 
CPW, you are right, I apologize. I will stop posting about the this type of issue despite my strong feelings and my 6 years of first had experience dealing with other corporate and private ODs in the area.

Just one final post with valid concerns: In quality of exam, there is no comparison most of the time. I say most because I have seen very good chain OD exams, but on average, they are not near the quality of private or group ODs. The other main concern is the pricing. Of course there is a mark up of materials, but it is not as high as chains. This price difference is seen in glasses, but also on contacts. The profit we make on contacts is close to nothing, but some of the chains sell them for below our cost. That means if we sell the contacts for the same price, we would actually lose money. This is mostly the manufacture's fault for selling them cheaper to the chains. I understand business in that when someone buys a lot of one product, the supplier can afford to sell for less but this is hard to understand when you are not making any money. So a chain is capable of buying hundreds of thousands of boxes to supply all the store in the us, while a private guy can only buy 10 or 20 of each Rx. This puts us at large disadvantage. Private practices are using buying groups, but we still can not group order nearly as much as Wal-mart, so we still can't make a profit if sold at the same price.
 
I hardly ever post on this board. The fight in NJ is over for now. The public and legislators have decided not to allow ODs to have surgical priviledges.
_______________________________________________
Academy and New Jersey Ophthalmologists Help Derail New Jersey O.D. Surgical Scope Bill


May 7, 2003


(Washington, D.C.)?Thanks to the unified efforts of the American Academy of Ophthalmology and the New Jersey Academy of Ophthalmology (NJAO), New Jersey State Assemblyman Van Drew (D), the sponsor of A-3364, the optometric surgical bill, officially withdrew his legislation from further consideration by the New Jersey State Assembly. ?Our objective was clear--the preservation of patient safety and quality care,? says Mike Brennan, MD, Academy secretary for state affairs. ?This message resonated strongly in the capital halls of Trenton and with the citizens of New Jersey.?

'In essence, A-3364 would have created a new health care provider--the ?optometric surgeon? but without medical school education, internship training and residency. Under provisions of this bill, optometrists could have performed a wide range of eye surgeries including refractive, retina, cataract, glaucoma, and lid surgeries. A-3364 also created an independent New Jersey Optometry Board that would have the authority to approve future O.D. surgical privileges. ?It is unbelievable that the O.D board, which is comprised of non-medical providers, would have had the authority to virtually grant a plenary license to optometrists practicing in New Jersey,? says Donald Cinotti, MD, Academy regional state affairs secretariat member.

The key to successfully derailing A-3364 was the strong partnership between the NJAO and Academy working to ensure that the patient risks associated with this legislation were well understood by the general public, media and state legislators. ?NJAO stubbornly opposed the bill and through accurate media representation showed the public dangers as well as conflict of interest issues that proved the misguided nature of this legislation,? says David Ringel, DO, president of the New Jersey Academy of Ophthalmology. ?As the public became aware of the special interests? support of the bill, legislators began to distance themselves from any association with A-3364, and it fell like a rock from the legislative agenda.?


Article from the AAO (www.aao.org)
 
...as we know more and more, then the more stratification we will have in professional practices, as well as addition of lower-level practictioners to take the work load off the higher level practitioners.

Clinical Laboratory Scientists (Med Techs) in California try to pass a bill to license "mid-level" practitionars (Medical Laboratory
Technicians) who could do some, but not all of what the CLS does. Reason? Demand for CLSs which won't be met by current levels of training schools.

27 years ago when I was in Paramedic school, it really irked one of the LVNs I worked with. When I asked him why, he said it was because with 6 mos of training I could do something that he, with well over 12 months of training could not do: start IVs.

When I was a paramedic, we had something called a "biophone." We could do advanced procedures...but not without contacting a physician (and then, later, an MICU Nurse) over the radio (biophone), and did not drop et tubes. Now paramedics operate on standing orders and drop et tubes.

And, of course, we now have "first responders" which can use AEDs...

And lest we forget...using stethoscopes used be something that only physicians did!!! Now we have Nurses and EMTs and Med. Assts and Nurses' Aides doing it!

PAs may have to work under a Physician's license...but I'd bet they can do (legally, within their scope of practice) almost what the GP (who hung out his shingle after internship) of 50 years ago did.

Scopes of practice change to meet changing demands as well as the lobbying efforts of various interested groups. To rigorously try to strait-jacket scopes of practice is an effort doomed to failure.

heart
 
"Scopes of practice change to meet changing demands as well as the lobbying efforts of various interested groups. To rigorously try to strait-jacket scopes of practice is an effort doomed to failure."

I agree with out about half of your post, but we're not talking about putting in IVs or using a stethoscope here. We're talking about when and when not to cut into someone's eye, which can cause permanent and irreparable damage. Nurses and EMTs are allowed to use stethoscopes but STILL are not allowed to put down an official diagnosis. They can provide assessments, but diagnosis are reserved for nurse practioner level trained professionals. Even at the nurse practioner level, their ability to recognize disease is limited. In addition, knowing how to use a stethoscope does not equate in knowing that there is something wrong. My 6 year old son can tell if there is "wheezing" but does he know what this means? Is it asthma, bronchitis, a foreign body, lung cancer, RSV, etc...???

When we deal with surgery, there is a certain level of standards needed to insure patient safety and quality. Perhaps this is difficult to illustrate to people who have not seen the diversity of problems and complications than can arise from surgical procedures; thus, I believe this is why the public can be fooled and non-surgical practioners argue for more rights. The former NJ OD bill allowed access to surgical procedures without any proper training. Too much power. Not enough training and background. This is morally and ethically wrong. It's more than just about money. It's about doing the right things for patients and taking care of their best interests.

As you say though, "Scopes of practice change to meet changing demands as well as the lobbying efforts of various interested groups". First, there isn't really a need for MORE ophthalmic surgeons. In fact, NJ has a GLUT of both ophthalmologists and optometrists. Even in the most rural parts of America, most people live within 30 -60 minutes of a licensed eye surgeon; thus, if surgery is necessary, then they have access. Without the need for more surgeons, then there shouldn't be any change then... right? Furthermore, some will argue that it will lower medicare/medicaid payments. This is a fallacy too because current medicare/medicaid policy PREVENTS practioners from charging lower than what is being reimbursed by the program. So the "need" for lower prices is just a lie to help support the lobbying efforts of the NJ OD Bill.

As for lobbying, clearly if the public and lawmakers are educated, it will be near impossible to pass a surgical bill for a group who traditionally are not surgically trained. Instead of trying to pass laws to make optometrists into surgeons, go to medical school and get the training to become one. I cannot imagine that the need for more ophthalmic surgeons is so high that we need more practioners in the US. We already have enough ophthalmic surgeons to handle the demand.

I find it interesting that NJ ODs are pushing for this bill when there is a glut of practioners in their state. Perhaps the better solution is regulation of the numbers of ODs admitted to optometry school rather than trying to ask lawmakers to pass laws to make them into something they are not... eye surgeons.
 
I think that when it comes to "scope of practice" issues the health care industry should take the same approach as does the airline industry. I get worried when I hear of allied health practitioners wanting to "do more" without necessarily wanting to go through the same rigorous training that physicians do. It's a dangerous short cut that ultimately short changes patients.

You ever notice that there are no "pilot assistants" or "advanced level flight attendant-aviators" in the airline industry? It's not that flight attendants, baggage handlers, and mechanics don't play pivotal roles in the operation and safety of aircraft; it's that they realize that their roles are different from pilots. Someone's got to steer the plane and be in charge and the airline industry has decided that individual should be maximally trained for just that task.

So, the airline industry spends millions of dollars training and OVERTRAINING pilots to deal with just about every conceivable dangerous flight situation possible. It's not that they couldn't teach a flight attendant or mechanic to fly a plane safely, they could. They could even probably demonstrate comparable outcomes between fully-trained pilots and "advanced level flight attendant-aviators" in fair weather conditions on routine flights. Still, the question becomes do you want someone with the MINIMUM level of competence performing a task that puts hundreds, if not thousands, of lives at risk or someone with the MAXIMUM level of training performing the task? As full physicians, we train (and overtrain) for a reason---to recognize the 1% of things that are difficult to predict, that are zebras, that life/limb/sight threatening. Yes, it is inefficient to train so long and so intense for such a small minority of occurences, but there is only one way to achieve this competence threshold and that is through training intensity and training duration.

Imagine stepping onto a plane for a "routine" commuter flight and hearing the following announcement over the PA, "Hi and welcome aboard XXX airlines. Your pilot today will be Shiela. Shiela has over 8 years of experience in the airline industry as a flight attendant and has recently completed a 14 month accelerated course in commercial aviation aircraft control..." Would you stay on the plane?
 
Originally posted by Ophtho_MudPhud
[
Furthermore, some will argue that it will lower medicare/medicaid payments. This is a fallacy too because current medicare/medicaid policy PREVENTS practioners from charging lower than what is being reimbursed by the program. So the "need" for lower prices is just a lie to help support the lobbying efforts of the NJ OD Bill.
[/B]
Click to expand...

Andrew,

You sorta lost me here. MCR/MCD to my knowledge doesn't prevent any practitioner from charging LESS for a procedure. They do prevent one from charging more........but not less. (I don't know why anyone would charge less anyway?)

Did I read you wrong?
 
Originally posted by TomOD
Andrew,

You sorta lost me here. MCR/MCD to my knowledge doesn't prevent any practitioner from charging LESS for a procedure. They do prevent one from charging more........but not less. (I don't know why anyone would charge less anyway?)

Did I read you wrong?
Click to expand...

I'm sorry, I meant that MCR/MCD prevents a practioner from charging their private patients LESS for a procedure than MCR/MCD patients. That was a typo. Thanks Tom.

The following is from the NJAO.

Q. Why won?t the expansion of optometric scope of practice reduce costs?

The fee schedule that Medicare and Medicaid uses is the same for optometrists and ophthalmologists. Moreover, federal law prohibits participating Medicare providers to charge private patients a lower fee than Medicare patients. Private insurers reimburse similarly to Medicare and Medicaid, using a standard set of billing codes. Therefore, ophthalmologists are paid the same for patient visits, work and consultation as optometrists. Seniors and other eye care consumers now benefit from superior care from ophthalmologists at no greater cost. This scope of practice expansion would create two tiers in the quality of medical eye care but at the same reimbursement rate. Indeed, many patients would seek a second opinion from an ophthalmologist, requiring duplicate testing and incurring additional costs. Evidence also suggests that optometrists have higher utilization rates for medical services, also increasing costs.
 
After reading these posts my two cents-
Go to Medical School if you want to deliver total eye care to your patients. Optometry School is a waste of time and money.
Aim higher in life and challenge yourself to the highest degree. The rewards will be much higher as an OMD than an OD.
Speaking from the heart.

RC
 
Most of the rest of you would beg to differ?.........when you wake up and smell the coffee you'll realize what a waste of time and money Optometry school was for all of you. Until then get your OD degree and work in the real world from the academic world you've been brainwashed.
You'll learn.........2010 and onwards it will hit you.


Regards,
 
You seem to speak with such authority about this as though you have actual experience with what you so ardently proselytize -- I'm just curious, what type of real-world experience do you have to support your fanatical views, RC?
 
OMG!

I can't believe this thing with RC is still going on!

🙄
 
Hi sweetie🙂

Sorry i've been a little absent lately. Been working crazy hours. Trying to store up as much money as possible before the big move....
 
RC-

What are you talking about? My father is still very happy with his carrer, Tom seems to like, doc Watson seem to like it, so did the ODs I asked to write my letters of rec. Perhaps you are the one with the distorted view of the world.

Two days ago I watched an ophtho perform 5 lasik surgeries. Pretty boring if you ask me. This surgeon was one of the first 20 is the country to do vision correction, and he is one of the best eye surgeons in the nation. This Tuesday I will watch several cateract removals. From what it looks like, every thing he does is pretty routine. He finishes one, and the next comes in. The lasik was not exciting. After watching it, I really have no real draw to do it myself. Then that same day I went and worked in my dad's office. I saw several interesting things. Every patient that afternoon had something different about them, and I learned a lot.

We all know how you feel about our choice of optometry. I believe I speak for everyone when I ask you to respect our choices.
 
well said, o partner of mine🙂
 
rpames,
I enjoy and love practicing Optometry to the fullest of my ability and according to my state legislature. I consider myself as an excellent clinician with outstanding personal skills. Most of my patients would agree with that statement. If I had to do it over again all I am saying is I would have chosen another route- and that would have been Medicine - Ophthalmology. You missed my point. You can be superb in your clinical skills, interpersonal skills, enjoy Optometry BUT wanting more out of it. You talk about how monotonous cataract and lasik surgery is after watching your OMD. You wish you had those skills to perform those routine procedures, earn the respect of your patients and carry a heavy responsibilty on your shoulders as they do along with the $$$$ they earn. Why is it that our own profession has come so far with therapeutics and in some states has introduced minor surgical procedures to Congress? What interesting things you see in your dads office is routine to the general ophthalmologist. Your point of view is worthless. I understand you are excited that you are about to matriculate in Optometry school as I was over a decade plus ago; but you will one day realize the grass was actually greener on the other side as I have.
Good Luck to you.
 
I would argue my point of view is NOT "worthless." But thanks for the responce.
 
No one on this boards point of view is "worthless". I'm sorry you're not happy with your career choice, but please allow those of us that are to matriculate in peace.
 
cpw,
Matriculate in peace. Don't let me stop you. I spoke for myself and resent the fact I should have aimed higher in life than becoming just an optometrist. I should have challenged myself further to fill that emptiness I feel professionally and financially today. Hey, if you're going to be happy with the money optometrists make today -good for you. I'm in my mid thirties and wish I had the stamina, drive and motivation to go back to school and get an MD and become an ophthalomolgist. But I can't it's too late for ME because I don't have the aforementioned.

Peace.
 
RC, it's never "too late" to make a change, especially when you're so unhappy. You make being in your 30s sound like the end of your life. If you really feel that way, you've got much bigger problems than just hating your job.
 
Originally posted by rpames
Hey RC-

Check out this site. You could be an MD in 3 years. This school also has a 5 yr program. Take a look. It is an option.

http://www.uhsa.com/pstudent/optometrist/
Click to expand...

Unfortunately, if you graduate from UHSA, then it will be very hard to land an ophthalmology residency afterwards. Not impossible, but very hard.
 
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