Creation of an Optometric Surgery Residency (analagous to OMFS for Dental)

[Oculomotor]

RATIONAL and REASONABLE DEBATE on this topic
NO FLAMING PLEASE

We have had numerous arguments and discussions regarding this topic on the OD and OMD forum on here. I feel this it the most rational solution to the issue of "establishing the lines" regarding primary eye care and ophthalmic surgery. We all know these facts are evident:

1) Dentists do NOT attend medical school and yet have Oral Maxillofacial Surgery (OMS). This is a 4-7 year resdency depending on the school and program. 80% of these surgeons have a certificate and do NOT have an MD (source American Dental Association).

2) The fact that the "eye" is a realm contained within optometry and medicine fuels the anger--discontent within the ranks of medicine because unlike dentistry which has no analagous route within medicine----optometrists and ophthalmologists share some territory.

3) Optometry from 1971 to present 2008 has evolved considerably in scope and training with OD's becoming the country's primary eye doctors (~75% of primary eye care is provided by OD's---source AOA, APHA, etc.....)

4) The Political climate surrounding optometry and ophthalmology is a heated one with absolute hatred for each other at an ORGANIZATIONAL LEVEL. Yet there is a lot of cooperation at the practitioner level.

PLEASE HAVE A RATIONAL OPINION AND LEAVE YOUR EMOTIONS OUT OF IT.....

1) For or against an optometry surgery residency (analagous to OMS) to solve the problem of surgery versus non surgery...

"JUST GO TO MEDICAL SCHOOL" is NOT an answer!!!!!!!!

2) If you are "for" then how would you set up the program (ie. length, requirement for entry, etc....)



Let the discussion begin.......

---

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[Jay12]

I think this would probably be the only solution for optometrists whom want to do surgery.......

I believe maybe even ophthalmologists might be in favor of having a residency in place, instead of having every optometrist being able to perform surgery....

 

[CatsandCradles]

RATIONAL and REASONABLE DEBATE on this topic
NO FLAMING PLEASE

We have had numerous arguments and discussions regarding this topic on the OD and OMD forum on here. I feel this it the most rational solution to the issue of "establishing the lines" regarding primary eye care and ophthalmic surgery. We all know these facts are evident:

1) Dentists do NOT attend medical school and yet have Oral Maxillofacial Surgery (OMS). This is a 4-7 year resdency depending on the school and program. 80% of these surgeons have a certificate and do NOT have an MD (source American Dental Association).

2) The fact that the "eye" is a realm contained within optometry and medicine fuels the anger--discontent within the ranks of medicine because unlike dentistry which has no analagous route within medicine----optometrists and ophthalmologists share some territory.

3) Optometry from 1971 to present 2008 has evolved considerably in scope and training with OD's becoming the country's primary eye doctors (~75% of primary eye care is provided by OD's---source AOA, APHA, etc.....)

4) The Political climate surrounding optometry and ophthalmology is a heated one with absolute hatred for each other at an ORGANIZATIONAL LEVEL. Yet there is a lot of cooperation at the practitioner level.

PLEASE HAVE A RATIONAL OPINION AND LEAVE YOUR EMOTIONS OUT OF IT.....

1) For or against an optometry surgery residency (analagous to OMS) to solve the problem of surgery versus non surgery...

"JUST GO TO MEDICAL SCHOOL" is NOT an answer!!!!!!!!

2) If you are "for" then how would you set up the program (ie. length, requirement for entry, etc....)



Let the discussion begin.......

I have deleted my post since this morning I looked at it again and saw that it was:

1 Unconstructive
2 Mean spirited
3 Represented gut and emotional reactions
4 The post was based on arguments, but diatribes
5 It was one made out in bitterness and not a good will one.
6 Born out of distrust

And nothing good will come out of adding more and more distrust on this topic. You can see what I wrote below as others have talked about it. I read my post today, and I thought a lunatic had wrote it. If you want to poke fun of me, then that's perfectly reasonable since I deserved it. For those of you who read that and got upset, then I can do nothing else but apologize for making such a lunatic comment such as that. In the past I have had uncontrolled outburst of random diatribes, and it keeps appearing every once and while. Some people get road rage, others get internet rage. Again I apologize to the readers of this forum.

C&C

 

[eyestrain]

Dear Lord. Anyone want to close this before it's too late?

 

[Jay12]

Exactly right!


1 If optometrist can do surgery - then we should advocate that ophthalmologist be eliminated! I've heard that line several times.


2 And since "we all know" that medical school students don't know anything about the eye - then shouldn't optometrist - not family med docs - be the only lawful people allowed to look into the eye. After all, the only thing family med docs do is see kids with runny and sniffy noses!


3 And shouldn't Paramedics and EMT Bs be allowed to become emegency physicians as well? After all they know more about emergency med than the EM doctors. Cause we all know the medical student who wants to become an EM doc doesn't know anything about emergency medicine - he or she only reads and looks at books, whereas the paramedics and EMT students train day in and day out. So obviously only the paramedics can become emergency physicians and not medical students.


4 And shouldn't we allow Doctor Nurse Practioners the right to do surgery too? After all, they're out their in the field doing all sorts of things and we all know that medical students still don't know anything by thier 3rd and 4th year. NPs are doing family medicine and they even know more than the family med because they are also nurses too. DNP students are right out doing clinical things from the get go - so it only makes sense that we allow NP to do surgery. They already are doctors and they are more holisitic!


5 And we all know that physical therapist know more about manual medicine than all doctors - so PTs should replace the Pain Managment doctors - cause we all know the Pain Management doctors are useless anyway - they just want to inject corticosteroids into joints. The MDs are useless drug pushers.


7 Chiropractors train with their hands all day long - whereas all those medical students going into OMM don't know anything anyway because they are reading Harrisons or Cecils - so isn't it obvious that Chiropractors - and not medical students can become OMM doctors. We all know the medical students despise OMM anyway. So only chiropractors should be allowed to do OMM and manual medicine. So you see! Chiropractors > MDs...er...uh..


8 Homeopathic and Naturalpathic doctors should replace the MDs because the we all know that the MDs are drug pushers and that HMGCoA reductaste inhibitors are all lies. We need to get back to our ancient roots people and use things like St Johns Worts. Natural medicine works! Stop MMR vaccinations!


9 Psychiatrist only want to use haloperidol anyway. So Psychologist should replace the Psychiatrist - after all it's just haloperidol any way. And how hard is it to decide what SSRI to use anyway? And Psychologist take the time to listen to the patient.


10 Occupational medicine doctors are useless to society. They exist because of all the drug seekers. Let us replace them with methadone drug rehab units.


11 We ceratintly also know that Anesthesiologist should be replaced with CRNAs - it's just obvious people! I don't need to explain that one.



Why the hell do we need doctors anyway - they are useless. We can have:

Paramedics should do emergency medicine
Nurse practioners should do family medicine
Optometrist should become eye surgeons
CRNAs should be anesthesiologist
Psychologist should replace pyschiatrist


Let us all unite and bring down these evil MDs. They are arrogant and the enemy of the world. Down with Harvard. Down with John Hopkins. Down with UCLA. All the research at these schools is lies people. Lies all of them. BRCA1 and Her2 are fake propaganda by the MDs. Tamoxifen is a fake drug that the oncologist like to talk about. It has no value at all. Just look at the latest scandal with Vytorin - the MDs are in bed with the pharmacutical companies! It is imperative that we do this - patient safety depends on it!

Beware all you MDs. You are going down!


Let us all unite and send all the MDs into the dark depths of radiology!!!!

Dude....you got way too much time on your hands.

 

[IndianaOD]

Dude....you got way too much time on your hands.

Agreed, and with all that typing I don't even know what the point was.

Don't even know what type of "health student" he or she is.

All I will say is our US system is massively inefficient. Too many years learning about stuff no practitioner will ever use. We had an OMD from eastern Europe at the OD school. She had 3 years post-high school training.

If med school is the magical gate that all must pass through to touch a hair on someones head, then dentists and podiatrists must be KILLING people by the thousands. Heck even naturalists can Rx meds in some states and I don't even know what one is.

PAs act as doctors with basically what amounts to little oversight with much less education.

I don't see why the AMA isn't screaming out loud about the dentists and podiatrists and the fact they didn't go through a school that had the correct label.

They really should keep their eye on those nurses that are taking over!

 

[sportvision]

i think a residency for optometrist to be able to do surgery is reasonable...just pick out the top 1-5% of the optometry graduating class...

 

[BS310]

CatsandCradles also believes that if gays are allowed to marry each other, people will marry donkeys next.

 

[gochi]

The presence of anecdotal hatred between OD's/OMD's leads me to conclude that sooner or later, OD's will be able to perform surgery with minor additional education.

But it's a give-take situation. If you want to do surgery you will have to undergo most of the things MD's have to go through, such as insurance, law suits, bad hours etc. which would somewhat diminish the fulfilling lifestyle of an Optometrist.

Question here, are Ophthalmologist's members of the AOA or is it strictly composed of Optometrists ?

 

[VA Hopeful Dr]

Agreed, and with all that typing I don't even know what the point was.

Don't even know what type of "health student" he or she is.

All I will say is our US system is massively inefficient. Too many years learning about stuff no practitioner will ever use. We had an OMD from eastern Europe at the OD school. She had 3 years post-high school training.

If med school is the magical gate that all must pass through to touch a hair on someones head, then dentists and podiatrists must be KILLING people by the thousands. Heck even naturalists can Rx meds in some states and I don't even know what one is.

PAs act as doctors with basically what amounts to little oversight with much less education.

I don't see why the AMA isn't screaming out loud about the dentists and podiatrists and the fact they didn't go through a school that had the correct label.

They really should keep their eye on those nurses that are taking over!

Dentists and Podiatrists are both trained to do what they do, that's why. Besides, there is animosity around them. OMFS guys and ENT/Ophth/Plastics get into fights decently often. Podiatrists want to move up the leg in terms of what they can do (or last I heard, they did). Ortho just loves that one. The trick, as I said, is that these folks are trained quite well in school to do exactly what they do. Dentists, as I recall, actually have to do a certain number of each procedure before they can graduate.

Tell me then, what procedures exactly and how many did you do on humans while you were a student/resident? That's really the key here, training.

 

[171590]

i think a residency for optometrist to be able to do surgery is reasonable...just pick out the top 1-5% of the optometry graduating class...

Definitely NOT a smart idea. Yes, you would want to select fully competent candidates for your program but merely being in the top 1-5% of your class cannot be the only qualifier. There would have to be some kind of spacial/tactile entrance exam or proficiency. Surgeons need to have "steady hands" and be able to visualize and comprehend depth perceptions at an extremely accurate level while being able to translate computer generated images/views to real structures. I'm sure you all had a lab partner or two who did phenomenal on exams and learning concepts but proved to be disastrous in labs. Those people are dangerous! They THINK they know what they are doing but sometimes, simple common sense and coordination escape them. A strong program would have to screen for these shortcomings in some academically qualified candidates.

 

[KHE]

RATIONAL and REASONABLE DEBATE on this topic
NO FLAMING PLEASE

We have had numerous arguments and discussions regarding this topic on the OD and OMD forum on here. I feel this it the most rational solution to the issue of "establishing the lines" regarding primary eye care and ophthalmic surgery. We all know these facts are evident:

1) Dentists do NOT attend medical school and yet have Oral Maxillofacial Surgery (OMS). This is a 4-7 year resdency depending on the school and program. 80% of these surgeons have a certificate and do NOT have an MD (source American Dental Association).



Let the discussion begin.......

It would be helpful for the purpose of this discussion to provide a link, or a much more detailed description of what the OMS program is like for dentists.

Is it 4-7 years AFTER dental school? What degree/certificate is granted? What additional procedures is a person who completes this training licensed to provide? How many dentists actually pursue this advanced training?

 

[MR1]

My honest questions to any OD that wants to do ocular surgery is, what surgeries are you talking about??

-cataract
-yag
-focal/PRP
-glaucoma
-retina
-refractive
-FB removal
-traumatic, corneal lacs, eyelid lacs, open globes
-chalazion I&D
-intravitreal injections
-subconj injections

And second if your answer includes anything except FB removal, chalazion, and maybe subconj injections... WHY? Is the arguement better access to care for those that live in small towns? Yes OD's scope is much better than it used to be and my opinion is that states or OMD's that say you can't use eye gtt or remove FB's are crazy.

So again my main question is WHY do OD's want to do ocular surgery???

 

[KHE]

My honest questions to any OD that wants to do ocular surgery is, what surgeries are you talking about??

-cataract
-yag
-focal/PRP
-glaucoma
-retina
-refractive
-FB removal
-traumatic, corneal lacs, eyelid lacs, open globes
-chalazion I&D
-intravitreal injections
-subconj injections

And second if your answer includes anything except FB removal, chalazion, and maybe subconj injections... WHY? Is the arguement better access to care for those that live in small towns? Yes OD's scope is much better than it used to be and my opinion is that states or OMD's that say you can't use eye gtt or remove FB's are crazy.

So again my main question is WHY do OD's want to do ocular surgery???

As a practicing OD with a highly "medically" oriented optometric practice....

The only "surgeries" I would "care" to do would be FB removals (which I already do) and chalazion removals. Perhaps, there is the occasional lid papilloma that I could see myself removing. Other than that, really nothing for a multitude of reasons, most of which I have gone over 100s of times but the main reasons are:

Optometry is a primary care field....the vast majority of ocular surgeries do not fall under the realm of primary care.

Economically, it makes little sense to do them. I don't have the volume, even with a high volume, medically oriented, two doctor practice. We just don't have the volume to make it worthwhile.

So for me, there is no answer to your why question since I'm not desirous of doing any of the others.

 

[hello07]

it's good to be back on the forums after a 2 week ban for letting my emeotions get the best of me with my responses to optometry and medical students.

Now, I would like also like to ask the question why do OD's want to do ocular surgery? perhaps, the person that started this thread can answer all of us?
tell us oculomotor why would we want to perform eye surgery and enact a surgical residency program on our behalf?

 

[gochi]

it's good to be back on the forums after a 2 week ban for letting my emeotions get the best of me with my responses to optometry and medical students.

Now, I would like also like to ask the question why do OD's want to do ocular surgery? perhaps, the person that started this thread can answer all of us?
tell us oculomotor why would we want to perform eye surgery and enact a surgical residency program on our behalf?

$

 

[MR1]

Optometry is a primary care field....the vast majority of ocular surgeries do not fall under the realm of primary care.

Economically, it makes little sense to do them. I don't have the volume, even with a high volume, medically oriented, two doctor practice. We just don't have the volume to make it worthwhile.

So for me, there is no answer to your why question since I'm not desirous of doing any of the others.

OD's provide the majority of primary eye care in the country and as a future OMD resident I am happy about that. I think OD's should be the primary eye docs in the majority of cases. So why pursue surgical training, as far as I can tell it doesn't take months to see an OMD or get surgery done by one (at least this is something I've never heard). There isn't a line out every OMD's office to get focal, PRP, or YAG done and definitely not one for refractive surgery. Now granted someone living far in the country might have to drive a few hours but I don't think that would be a good arguement.

Yes ocular surgery is only available through med school whereas dentists and podiatrists do it without going to med school. It is just the way it is, if I had designed the system 200 yrs ago I probably would have done it differently. Now unless I am missing something, I don't see the need for optometric surgeons.

 

[Oculomotor]

I started this thread to just have a reasonable debate or input about this subject. I for one do not have all the answers based on my limited experience with optometry (especially clinically). The "thought" of an optometric surgery residency seems to produce reactions from placid to acrimonious. This is a very sensitive topic but a very important one.

Optometry needs a uniform scope of practice nationwide

• Very imposing task because no state legislature wants to relinquish control over a well funded constituency for re-election.

Optometry should have a route for the small number of OD's that want to provide more invasive care (i.e. surgery).

• Doing 4 years of undergrad + 4 years of optometry school, and then ooops I would like to do surgery oh darn------->4 years of medical school (almost NO eye related training whatsoever) + 1 year of internship + 3 years of ophthalmology residency and there you go! 16 years to do ophthalmic surgery if you are already an OD. That is ridiculous and a waste.

• Dentistry has Oral Maxillofacial Surgery (OMFS or OMS) with a (typically) 4 year residency program after one earns his DMD or DDS.

• Sample program from the Washington Hospital Center:

Months on Rotation TOTAL R1 R2 R3 R4 OMFS 36 10 6 8* 12 Anesthesia
5 2 3** - - Internal Medicine
1 1 - - - Cardiology
1 - 1 - - General Surgery
1 - 1 - - Shock/Trauma
1 - - 1 - Surgical ICU
2 - - 2 - * includes three months at Washington VA Medical Center
** includes one month at Children's National Medical Center
First Year
As you progress through your years as a resident your educational needs and interests change. The oral & maxillofacial surgery program is designed to meet those evolving needs. In the first year of training, residents will:

• gain extensive experience in dentoalveolar procedures in the outpatient clinic;
• learn how to perform a complete maxillofacial trauma examination on patients who have suffered blunt or penetrating trauma, gunshot wounds, traffic accidents, and other injuries with emphasis on diagnosis and treatment planning;
• complete a course in physical diagnosis/physical examination;
• evaluate presurgical orthognathic patients and actively participate in their work-up and treatment planning;
• regularly perform formal case presentations to the attending staff and participate in monthly journal clubs;
• participate in operating room surgeries;
• learn the management of soft tissue wounds, primarily through the emergency department and shock/trauma unit.

Second Year
In their second year of training, residents will:

• refine their technical skills in dentoalveolar surgery;
• provide parenteral anesthesia on an outpatient basis;
• regularly perform formal case presentations to the attending staff and actively participate in monthly Journal Clubs;
• participate extensively in operating room surgeries;
• present a poster project at the hospital's annual Research Day;
• learn the management of soft tissue wounds, primarily through the emergency department and the shock/trauma unit.

Third Year
In their third year of training, residents will:

• refine their skills in outpatient parenteral anesthesia;
• spend three months managing both inpatients and outpatients at the Veterans Administration Medical Center;
• actively participate in the education and training of more junior residents;
• regularly perform formal case presentations to the attending staff and participate in monthly journal clubs;
• present a poster project at the hospital's annual Research Day;
• take a more active role in operating room cases, learning a wide variety of surgical techniques.

Fourth Year
In their fourth year of training, residents will:

• spend six months as administrative chief resident;
• refine their surgical techniques through extensive participation in operating room cases, including diagnosis and treatment planning of orthognathic and other elective cases;
• actively participate in the education and training of more junior residents;
• gain extensive experience in outpatient general anesthesia and refine techniques for the surgical management of impacted teeth;
• present a poster at the hospital's annual Research Day;
• gain valuable exposure to private practice oral and maxillofacial surgery by visiting the private offices of attending staff.

This program like most OMS programs does not reward the resident upon completion of the program with an MD---------> this is a small minority of programs. 80+ of Dental Surgeons are Dentists (DDS, DMD.)

Why not optometry?

Dentistry is a primary care field as well and they have available to them Oral Maxillofacial Surgery, Orthodontics, Endodontics, Periendodontics, etc.... 90% of Dental graduates go into General Dentistry (primary care dentistry)

We are talking about at most maybe 50 OD grads a year out of 1200 or so pursuing an optometric surgery residency. Only the top 1-2 % of the OD grads would be eligeable or even desiring of this.
Professional Evolution of Optometry

This would not flood the market with ophthalmic surgeons.
We would have a segment of our profession providing the most tertiary care while the majority provide primary care. It is evolution my friend.

The Dental Profession should be the model that Optometry should emulate.

I have heard this opinion echoed by several OD clinicians that I know. Dentistry is better organized have far less limitations (ie prescriptive authority--etc...) within their scope of practice. Dentistry is self-contained more so than optometry and has no analog within the medical profession.

Hypothetical model

4 year optometry school

• select the few applicants from the most competitive in the school
• put them on a "modified" track where they do some medical school rotations thru select areas such as internal medicine, surgery, opthalmology, etc in the beginning of their 3rd year of OD school.
• the OD program for them would be 4.5 years instead of 4
• after OD school you do residency program (like OMS) where you learn most of the surgical skills (like OMS) in the 4 year Optometric Surgery Residency.
• NO USMLE or COMLEX, just a self-contained program training optometric surgeons.

Respect and Access

A surgical route for OD's would give our profession more respect, more access to hospitals, set a precedent for the profession as a whole which would far outweigh the greater risk and cost.

Personally I want to practice "Medical Optometry" in the future (kind of like what KHE mentioned) and would not want to do a surgery residency but I feel that having a surgical pathway for our profession would be a monumental step forward and would prevent a future of -----------------> "In this state I can't do injectable drugs but I cross the border into that state and I can do PRK."--------that is ridiculous

Again this is just my lone opinion and not meant to rub anyone the wrong way. We are a very decent and respectable profession and we should be able to talk about this subject with mutual respect.

Any input colleagues? (OD or MD/DO)

 

[KHE]

OD's provide the majority of primary eye care in the country and as a future OMD resident I am happy about that. I think OD's should be the primary eye docs in the majority of cases. So why pursue surgical training, as far as I can tell it doesn't take months to see an OMD or get surgery done by one (at least this is something I've never heard). There isn't a line out every OMD's office to get focal, PRP, or YAG done and definitely not one for refractive surgery. Now granted someone living far in the country might have to drive a few hours but I don't think that would be a good arguement.

I think we can all agree that there is surgery, and then there is SURGERY. You and I are basically in agreement on this, however.

Yes ocular surgery is only available through med school whereas dentists and podiatrists do it without going to med school. It is just the way it is, if I had designed the system 200 yrs ago I probably would have done it differently. Now unless I am missing something, I don't see the need for optometric surgeons.

Both of those professions have historically been "surgical" in nature, just by virtue of the procedures done. Optometry hasn't. Now....I don't doubt that you could set up a 4 year post university program to train competent eye surgeons, just like dentistry and podiatry does but the fact is that right now optometric education is not really structured to do it, and there really isn't any reason to do it. You are right...there are not huge back logs in rural areas of patients in desperate need of eye surgery, and even in the few areas of the country where you might POSSIBLY be able to make the argument that there are, there is simply no guarantee, nor any real likelihood that any future "optometric surgeon" would choose to practice there.

 

[CatsandCradles]

I started this thread to just have a reasonable debate or input about this subject. I for one do not have all the answers based on my limited experience with optometry (especially clinically). The "thought" of an optometric surgery residency seems to produce reactions from placid to acrimonious. This is a very sensitive topic but a very important one.

Optometry needs a uniform scope of practice nationwide

• Very imposing task because no state legislature wants to relinquish control over a well funded constituency for re-election.

Optometry should have a route for the small number of OD's that want to provide more invasive care (i.e. surgery).

• Doing 4 years of undergrad + 4 years of optometry school, and then ooops I would like to do surgery oh darn------->4 years of medical school (almost NO eye related training whatsoever) + 1 year of internship + 3 years of ophthalmology residency and there you go! 16 years to do ophthalmic surgery if you are already an OD. That is ridiculous and a waste.

• Dentistry has Oral Maxillofacial Surgery (OMFS or OMS) with a (typically) 4 year residency program after one earns his DMD or DDS.

• Sample program from the Washington Hospital Center:

Months on Rotation TOTAL R1 R2 R3 R4 OMFS 36 10 6 8* 12 Anesthesia
5 2 3** - - Internal Medicine
1 1 - - - Cardiology
1 - 1 - - General Surgery
1 - 1 - - Shock/Trauma
1 - - 1 - Surgical ICU
2 - - 2 - * includes three months at Washington VA Medical Center
** includes one month at Children’s National Medical Center
First Year
As you progress through your years as a resident your educational needs and interests change. The oral & maxillofacial surgery program is designed to meet those evolving needs. In the first year of training, residents will:

• gain extensive experience in dentoalveolar procedures in the outpatient clinic;
• learn how to perform a complete maxillofacial trauma examination on patients who have suffered blunt or penetrating trauma, gunshot wounds, traffic accidents, and other injuries with emphasis on diagnosis and treatment planning;
• complete a course in physical diagnosis/physical examination;
• evaluate presurgical orthognathic patients and actively participate in their work-up and treatment planning;
• regularly perform formal case presentations to the attending staff and participate in monthly journal clubs;
• participate in operating room surgeries;
• learn the management of soft tissue wounds, primarily through the emergency department and shock/trauma unit.

Second Year
In their second year of training, residents will:

• refine their technical skills in dentoalveolar surgery;
• provide parenteral anesthesia on an outpatient basis;
• regularly perform formal case presentations to the attending staff and actively participate in monthly Journal Clubs;
• participate extensively in operating room surgeries;
• present a poster project at the hospital’s annual Research Day;
• learn the management of soft tissue wounds, primarily through the emergency department and the shock/trauma unit.

Third Year
In their third year of training, residents will:

• refine their skills in outpatient parenteral anesthesia;
• spend three months managing both inpatients and outpatients at the Veterans Administration Medical Center;
• actively participate in the education and training of more junior residents;
• regularly perform formal case presentations to the attending staff and participate in monthly journal clubs;
• present a poster project at the hospital’s annual Research Day;
• take a more active role in operating room cases, learning a wide variety of surgical techniques.

Fourth Year
In their fourth year of training, residents will:

• spend six months as administrative chief resident;
• refine their surgical techniques through extensive participation in operating room cases, including diagnosis and treatment planning of orthognathic and other elective cases;
• actively participate in the education and training of more junior residents;
• gain extensive experience in outpatient general anesthesia and refine techniques for the surgical management of impacted teeth;
• present a poster at the hospital’s annual Research Day;
• gain valuable exposure to private practice oral and maxillofacial surgery by visiting the private offices of attending staff.

This program like most OMS programs does not reward the resident upon completion of the program with an MD---------> this is a small minority of programs. 80+ of Dental Surgeons are Dentists (DDS, DMD.)

Why not optometry?

Dentistry is a primary care field as well and they have available to them Oral Maxillofacial Surgery, Orthodontics, Endodontics, Periendodontics, etc.... 90% of Dental graduates go into General Dentistry (primary care dentistry)

We are talking about at most maybe 50 OD grads a year out of 1200 or so pursuing an optometric surgery residency. Only the top 1-2 % of the OD grads would be eligeable or even desiring of this.
Professional Evolution of Optometry

This would not flood the market with ophthalmic surgeons.
We would have a segment of our profession providing the most tertiary care while the majority provide primary care. It is evolution my friend.

The Dental Profession should be the model that Optometry should emulate.

I have heard this opinion echoed by several OD clinicians that I know. Dentistry is better organized have far less limitations (ie prescriptive authority--etc...) within their scope of practice. Dentistry is self-contained more so than optometry and has no analog within the medical profession.

Hypothetical model

4 year optometry school

• select the few applicants from the most competitive in the school
• put them on a "modified" track where they do some medical school rotations thru select areas such as internal medicine, surgery, opthalmology, etc in the beginning of their 3rd year of OD school.
• the OD program for them would be 4.5 years instead of 4
• after OD school you do residency program (like OMS) where you learn most of the surgical skills (like OMS) in the 4 year Optometric Surgery Residency.
• NO USMLE or COMLEX, just a self-contained program training optometric surgeons.

Respect and Access

A surgical route for OD's would give our profession more respect, more access to hospitals, set a precedent for the profession as a whole which would far outweigh the greater risk and cost.

Personally I want to practice "Medical Optometry" in the future (kind of like what KHE mentioned) and would not want to do a surgery residency but I feel that having a surgical pathway for our profession would be a monumental step forward and would prevent a future of -----------------> "In this state I can't do injectable drugs but I cross the border into that state and I can do PRK."--------that is ridiculous

Again this is just my lone opinion and not meant to rub anyone the wrong way. We are a very decent and respectable profession and we should be able to talk about this subject with mutual respect.

Any input colleagues? (OD or MD/DO)

Oculomotor, I am sorry for making that really upsetting and mean comment earlier. I'll try to get back to this thread later on.

 

[gochi]

Maybe the surgery part could be implemented on the new schools opening up ?

 

[IndianaOD]

Glad to see things are staying civil.

I think there needs to be a big distinction between standard optometric education and a separate post doctoral training period.

Like the above posters, most ODs have no desire to do intra-ocular surgery. The thing is I think ODs should be allowed to further their training IF THEY WANT TO.

Standard ODs wouldn't be doing the surgery, it would be 2+ year residency trained OD surgeons.

For those who say go to med school, did you have everything figured out when you first started year 1? Heck many MDs started out thinking one thing but ended up doing something completely different. An OD student might have wanted to do primary care from the start but later decide he/she wanted to do more.

To be honest I have no desire to do cataracts or trabs etc. I would like the option of ocular injections and removing benign lesions. Retinal laser should be a 1 year residency if desired.

 

[stonegoat]

I practice primary care optometry, and honestly am very busy...I really can't imagine adding surgery to my plate.

I do think many ODs would make great surgeons if they had a residency after OD school....but why?? The demand simply isn't there. Even OMDs have to compete for surgical cases in many areas. Adding ODs to the mix would not be viable.

I am proud to be an OD... I love what I do, and I do many things better than the average OMD. However, I am NOT a surgeon, and think eye surgery should be left in the hands of those extensively trained to do it..the OMDs.

 

[Oculomotor]

Thanks to everyone for staying civil! thumbs up


"Like the above posters, most ODs have no desire to do intra-ocular surgery. The thing is I think ODs should be allowed to further their training IF THEY WANT TO."


I agree with Indiana OD. This is not about supply and demand or if there is a space in the market for an optometric surgeon. Rather, it is much more indicative of the profession of optometry having a route to complete the "continuum of care" from primary through tertiary. We are the ONLY independent doctoral level "medical" health care practitioner (i.e. optometry, dentistry, podiatry) that does not have a "surgical" or "tertiary care" route. Future optometric surgeons would only augment the 12000 or so ophthalmologists out there not become the model for optometry! If you started such a route this year, hypothetically, graduating 50 nationwide every 3 years (assuming a 3 yr residency), you would only have 150 optometric surgeons on the market by 2017 and only 300 by 2026! A very small number compared to the 12000 or so ophthalmologists out there. The financial impact on them would be negligable. I think the purpose of having a "surgical route" for OD's is more for the "conceptual" aspect and "evolution" of a field such as optometry that 38 years ago had no pharmaceutical privileges! lol

Again, Dentistry should be the model we emulate because as I mentioned earlier 90+ % of Dentists are (primary care dentists--general dentists) and the other 10% fill the specialty ranks. Optometry will always be the "primary eye doctor field" but we should be on equal footing with Dentistry and Podiatry in this regard and have the "full spectrum" of care within the field.....


Any comments colleagues? (OD, MD/DO, DDS/DMD, DPM)
Any Dentists or Podiatrists want to chime in? thanks

 

[KHE]

Thanks to everyone for staying civil! thumbs up





I agree with Indiana OD. This is not about supply and demand or if there is a space in the market for an optometric surgeon. Rather, it is much more indicative of the profession of optometry having a route to complete the "continuum of care" from primary through tertiary.

See, this is where I disagree. It SHOULD be about whether there is space in the market, not some ODs regret that they didn't pursue the surgical route earlier in their careers. Also, dentistry and podiatry have historically been surgical in nature just by virtue of the procedures they do. As such, it isn't nearly as much of a "leap" for them to take on additional, or more advanced procedures.

We are the ONLY independent doctoral level "medical" health care practitioner (i.e. optometry, dentistry, podiatry) that does not have a "surgical" or "tertiary care" route.

This is where the profession of optometry becomes slightly schizophrenic. We always bang the drum that we are THE primary eye care profession. Yet we want to be tertiary as well. Well, which is it? I think that for the profession as a whole, it is going to be much more problematic in the long term to become more "like them." We should be promoting and expanding optometry's strengths, not trying to be "like them."

[
Future optometric surgeons would only augment the 12000 or so ophthalmologists out there not become the model for optometry! If you started such a route this year, hypothetically, graduating 50 nationwide every 3 years (assuming a 3 yr residency), you would only have 150 optometric surgeons on the market by 2017 and only 300 by 2026! A very small number compared to the 12000 or so ophthalmologists out there. The financial impact on them would be negligable. I think the purpose of having a "surgical route" for OD's is more for the "conceptual" aspect and "evolution" of a field such as optometry that 38 years ago had no pharmaceutical privileges!

So you are only going to take 50 people every 3 years, or is it gong to be 50 people PER year? Those are two very different statements. Also, no one has made mention of who is going to provide this training? Are we going to set up our own "surgical" training programs? Staffed by who? With what money? Or are you expecting to piggy back on the surgical infrastructure that is already in place?

[
Again, Dentistry should be the model we emulate because as I mentioned earlier 90+ % of Dentists are (primary care dentists--general dentists) and the other 10% fill the specialty ranks. Optometry will always be the "primary eye doctor field" but we should be on equal footing with Dentistry and Podiatry in this regard and have the "full spectrum" of care within the field.....

I still think it's apples to oranges. Yes, both fields have "4 year" degree programs, but the training is completely different. Could you train a competent eye surgeon in 4 years of specialty eye training? Probably. But optometry isn't set up like that now, and I don't even think that current optometric education provides close to enough of a foundation to "go on" to become surgeons. And there isn't anything wrong with that. Again, let's accentuate our strengths, not try to be more "like them."

[/QUOTE]

 

[jonwill]

Thanks to everyone for staying civil! thumbs up


"Like the above posters, most ODs have no desire to do intra-ocular surgery. The thing is I think ODs should be allowed to further their training IF THEY WANT TO."


I agree with Indiana OD. This is not about supply and demand or if there is a space in the market for an optometric surgeon. Rather, it is much more indicative of the profession of optometry having a route to complete the "continuum of care" from primary through tertiary. We are the ONLY independent doctoral level "medical" health care practitioner (i.e. optometry, dentistry, podiatry) that does not have a "surgical" or "tertiary care" route. Future optometric surgeons would only augment the 12000 or so ophthalmologists out there not become the model for optometry! If you started such a route this year, hypothetically, graduating 50 nationwide every 3 years (assuming a 3 yr residency), you would only have 150 optometric surgeons on the market by 2017 and only 300 by 2026! A very small number compared to the 12000 or so ophthalmologists out there. The financial impact on them would be negligable. I think the purpose of having a "surgical route" for OD's is more for the "conceptual" aspect and "evolution" of a field such as optometry that 38 years ago had no pharmaceutical privileges! lol

Again, Dentistry should be the model we emulate because as I mentioned earlier 90+ % of Dentists are (primary care dentists--general dentists) and the other 10% fill the specialty ranks. Optometry will always be the "primary eye doctor field" but we should be on equal footing with Dentistry and Podiatry in this regard and have the "full spectrum" of care within the field.....


Any comments colleagues? (OD, MD/DO, DDS/DMD, DPM)
Any Dentists or Podiatrists want to chime in? thanks

I'm a DPM who is currently doing a 3-year surgical residency. From my point of view, it all comes down to whether it's needed or not. The history of podiatry is one that filled the void of ortho. There wasn't and still isn't consistent training in foot and ankle surgery in ortho residency. In 5 years of surgery, orthopods do as little as 4 weeks of foot surgery. Very few orthopods do any type of foot and ankle fellowship. And anyone who has ever worked with orthopods knows they have enough to deal with as it is. There was a need for foot surgeons and it was filled. Today, podiatrists are members of medical staff, have surgical privileges, and are now considered part of the mainstream medical community. I'm actually in residency at one of the largest allopathic teaching hospitals in the country. That is a long way away from your friendly neighborhood podiatrist 30 years ago that had a small office in a shopping center and clipped nails, corns, and callouses all day!

My comment would be that if there are already enough opthamologists performing surgery, than it will be fairly difficult for optometry to turn that corner. There would be no need. However, if there aren't enough opthamologists and not enough docs are going into that particular specialty, then that would create a void that would need to be filled.

I have always heard that optho is an extremely competitive residency. If that is true, then there probably isn't a shortage of eye surgeons.

Just my thoughts.

 

[gochi]

I'm a DPM who is currently doing a 3-year surgical residency. From my point of view, it all comes down to whether it's needed or not. The history of podiatry is one that filled the void of ortho. There wasn't and still isn't consistent training in foot and ankle surgery in ortho residency. In 5 years of surgery, orthopods do as little as 4 weeks of foot surgery. Very few orthopods do any type of foot and ankle fellowship. And anyone who has ever worked with orthopods knows they have enough to deal with as it is. There was a need for foot surgeons and it was filled. Today, podiatrists are members of medical staff, have surgical privileges, and are now considered part of the mainstream medical community. I'm actually in residency at one of the largest allopathic teaching hospitals in the country. That is a long way away from your friendly neighborhood podiatrist 30 years ago that had a small office in a shopping center and clipped nails, corns, and callouses all day!

My comment would be that if there are already enough opthamologists performing surgery, than it will be fairly difficult for optometry to turn that corner. There would be no need. However, if there aren't enough opthamologists and not enough docs are going into that particular specialty, then that would create a void that would need to be filled.

I have always heard that optho is an extremely competitive residency. If that is true, then there probably isn't a shortage of eye surgeons.

Just my thoughts.

Alright.

With that said, how do you explain the opening of new optometry schools which will pump out more grads then needed ? There not going to stop opening up new schools, so why should we stop fighting for the possibility of od's doing surgery ?

 

[MR1]

Alright.

With that said, how do you explain the opening of new optometry schools which will pump out more grads then needed ? There not going to stop opening up new schools, so why should we stop fighting for the possibility of od's doing surgery ?

That is not our fault, if I were an OD I'd be mad and try to stop that any way possible. OMD residency spots increase by maybe 1-2 each year with most years none being added and there is a reason for that, we don't want to oversaturate.

As far as other comments, I just don't agree OD's need a surgical route and the arguement that someone gets to the end of OD training and decides they want to be able to operate just doesn't cut it. I am sorry, many people every year finish med school, nursing school, dentist school, etc and decide to do something else. I researched my options very well, (I took the OAT's and almost applied to OD school). Post college education isn't something you just decide on a whim

I also totally disagree that it would add more respect to your profession, that just doesn't make sense to me.. WHY would it. Also why want access to hospitals? there is almost no need even for OMD's.

I do agree your scope should be federal and not state and shouldn't be so restrictive. I also agree with KHE - dentristy and podiatry are procedural/surgical in nature and have always been. Optometry hasn't and really there isn't a need to be

 

[IndianaOD]

That is not our fault, if I were an OD I'd be mad and try to stop that any way possible. OMD residency spots increase by maybe 1-2 each year with most years none being added and there is a reason for that, we don't want to oversaturate.

As far as other comments, I just don't agree OD's need a surgical route and the arguement that someone gets to the end of OD training and decides they want to be able to operate just doesn't cut it. I am sorry, many people every year finish med school, nursing school, dentist school, etc and decide to do something else. I researched my options very well, (I took the OAT's and almost applied to OD school). Post college education isn't something you just decide on a whim

I also totally disagree that it would add more respect to your profession, that just doesn't make sense to me.. WHY would it. Also why want access to hospitals? there is almost no need even for OMD's.

I do agree your scope should be federal and not state and shouldn't be so restrictive. I also agree with KHE - dentristy and podiatry are procedural/surgical in nature and have always been. Optometry hasn't and really there isn't a need to be

The problem is most all MDs have no idea how well trained ODs are. That and the fact the ODs are not present in the medical/surgery world means that joe family doc will refer a patient to an OMD 90% of the time. Respect matters. MDs blocking ODs from medical insurances also matters.

Plus to be honest, medical conditions many times are easier and less time consuming to treat than primary care and pay MUCH higher. For example - a foreign body visit might take 5 minutes of doctor time and reimburse $150. Solving someones double vision may take 20 minutes of doctor time with much more problem solving skill and reimburse $80 if you are lucky.

I can look for retinal hemes as well as any OMD so why would MY patient be told to see an OMD?

Making a doctorally educated optometrist go through 4 years of med school plus a trans year to further their eye care training is INSULTING.

Its all because of money with the OMDs, period. Its never patient safety. Every scope expansion has shown immaculate safety data. Go look it up if you don't believe it. Even one of the favorite OMDs on SDN (Doan) admitted its all about the money.

Let ODs determine their own training, medicine has no business in the matter.

 

[Olddog1]

The problem is most all MDs have no idea how well trained ODs are. That and the fact the ODs are not present in the medical/surgery world means that joe family doc will refer a patient to an OMD 90% of the time. Respect matters. MDs blocking ODs from medical insurances also matters.

I can look for retinal hemes as well as any OMD so why would MY patient be told to see an OMD?

If you think doing surgery will "legitimize" ODs in the mind of MDs you are mistaken. It is likely not about an OD's skill, it has more to do with throwing a bone to someone you stayed up with all night during your 3rd year of med school admitting patients with CHF, COPD, liver failure, blunt trauma,etc... People who can relate to your shared experience. In the past you have stated ODs should refer to ODs. How is this any different? While I don't disagree that an OD could easily say a newly diagnosed diabetic doesn't have NPDR, why would I tell a local FP MD that when someone like yourself always says "if you are not comfortable handling something refer to another OD first not an OMD".

Numerous times you have stated "ODs are the primary care doctors", why add surgery? As KHE stated you are comparing apples to oranges. Podiatry and denistry already do invasive procedures, optometry, with the exception of FB removal, do not. The ACGME has kept OMD graduates steady for at least the last decade, as noted on many threads the OD schools have not been so inclined. If you plan to turn out OD surgeons, plan to see alot more OMDs and everyone's reimbursement will plummet more than it already has, or is projected to. There is an avenue for an OD to pursue surgery, one that has been taken my many, go to medical school, then do a residency. Most ODs I know are doing quite well, and none as far as I know have a desire to do surgery. The concept of OD surgery is another $$ making idea because the OD schools know that turning out this number of grads for the next 20 years will not be sustainable, from a demand standpoint, and they are trying to create a new niche to fill.

 

[Olddog1]

The problem is most all MDs have no idea how well trained ODs are. That and the fact the ODs are not present in the medical/surgery world means that joe family doc will refer a patient to an OMD 90% of the time. Respect matters. MDs blocking ODs from medical insurances also matters.

I can look for retinal hemes as well as any OMD so why would MY patient be told to see an OMD?

If you think doing surgery will "legitimize" ODs in the mind of MDs you are mistaken. It is likely not about an OD's skill, it has more to do with throwing a bone to someone you stayed up with all night during your 3rd year of med school admitting patients with CHF, COPD, liver failure, blunt trauma,etc... People who can relate to your shared experience. In the past you have stated ODs should refer to ODs. How is this any different? While I don't disagree that an OD could easily say a newly diagnosed diabetic doesn't have NPDR, why would I tell a local FP MD that when someone like yourself always says "if you are not comfortable handling something refer to another OD first not an OMD".

Numerous times you have stated "ODs are the primary care doctors", why add surgery? As KHE stated you are comparing apples to oranges. Podiatry and denistry already do invasive procedures, optometry, with the exception of FB removal, do not. The ACGME has kept OMD graduates steady for at least the last decade, as noted on many threads the OD schools have not been so inclined. If you plan to turn out OD surgeons, plan to see alot more OMDs and everyone's reimbursement will plummet more than it already has, or is projected to. There is an avenue for an OD to pursue surgery, one that has been taken my many, go to medical school, then do a residency. Most ODs I know are doing quite well, and none as far as I know have a desire to do surgery. The concept of OD surgery is another $$ making idea because the OD schools know that turning out this number of grads for the next 20 years will not be sustainable from a demand standpoint, and they are trying to create a new niche to fill.

 

[VA Hopeful Dr]

The problem is most all MDs have no idea how well trained ODs are. That and the fact the ODs are not present in the medical/surgery world means that joe family doc will refer a patient to an OMD 90% of the time. Respect matters. MDs blocking ODs from medical insurances also matters.

I'll agree that blocking from insurance is a pretty crappy way to go about things, but then everything about insurance these days sucks. As for the other - well I'll start off with the old axiom Respect is Earned, not Given. That being said, I'll explain to you my little world view on this matter. As I've said many times, my dad and both of his parents were optometrists. I have a huge amount of respect for your profession and, everything else being equal, will likely refer most eye stuff to you guys. So, ODs have earned my respect since I've seen how good y'all are. On the other hand, I've also lost a huge amount of respect reading what you think both here and on ODWire. Now granted, I take ODWire with a huge grain of salt since we all know that people talk differently in private. Still, some of the just nasty opinions I hear in both places about my future profession really bother me.

Plus to be honest, medical conditions many times are easier and less time consuming to treat than primary care and pay MUCH higher. For example - a foreign body visit might take 5 minutes of doctor time and reimburse $150. Solving someones double vision may take 20 minutes of doctor time with much more problem solving skill and reimburse $80 if you are lucky.

Welcome to the world of primary care. FP and IM have the exact same problems. Maybe you could approach the AAFP and offer to help work on reimbursements for office time/preventative care. Even if it didn't work, might earn you some of that respect we were talking about.

I can look for retinal hemes as well as any OMD so why would MY patient be told to see an OMD?

Making a doctorally educated optometrist go through 4 years of med school plus a trans year to further their eye care training is INSULTING.

Its all because of money with the OMDs, period. Its never patient safety. Every scope expansion has shown immaculate safety data. Go look it up if you don't believe it. Even one of the favorite OMDs on SDN (Doan) admitted its all about the money.

Let ODs determine their own training, medicine has no business in the matter.

The simple answer to the first is exactly what Olddog said. As for the second, go look at everything Caffeinated has said. He did OD school then med school, now in ophtho residency. He's one of the few who has done it this way, why not ask his opinion to see how important the whole process is. Or you could just be insulted, that is easier after all.

Of course its about money, everything is. That doesn't make it wrong to oppose it. As always, KHE has written at length on this topic and, as usual, he's right.

Medicine has a business in this until a good study is produced showing that you guys can safely do the things you want to do and that there is a need for you to do it. Oklahoma won't work - from my understanding not many ODs do laser work there, self-selecting out of doing it. Unless you standardize your education so that every graduate can do this stuff, you've no business doing it.

Now, to end on a snarky note, if medicine has no business in this, then you guys have no business in blocking opticians from refracting.

 

[MR1]

Making a doctorally educated optometrist go through 4 years of med school plus a trans year to further their eye care training is INSULTING.

Its all because of money with the OMDs, period. Its never patient safety. Every scope expansion has shown immaculate safety data. Go look it up if you don't believe it. Even one of the favorite OMDs on SDN (Doan) admitted its all about the money.

Let ODs determine their own training, medicine has no business in the matter.

It isn't INSULTING, it is just how it is. If someone is thinking about OD vs MD school, they need to consider what they will be able to do. If someone goes to dental school and decides, ya know I'dd rather do "input any medical speciality" they have to go to medical school. Now if any med school wants to comp OD's ~1 year of basic science I am fine with that.

I know how trained you guys are and am fine with expansion for everything except surgery, the reason why is you get trained in it. You are not trained in surgery and again there is no reason to. There is NO NEED for it. Do you think opticians should be able to refract, or even do basic eye exams?? Just like OMD's don't think OD's should do surgery. It's all about money, well in some ways yes, we are all protecting our "turf" that we worked very hard to get. You 4-5 years, me 8-10. Either way it doesn't matter, we both worked hard. Be proud of who you are. You went to OD school, protect that. I went to MD school and I'll protect that. If joe blow wants to start dispensing glasses, I guess opticians will protect their turf.

And lastly your training when it comes to surgery IS our business because it is what we do.

 

[qwopty99]

It isn't INSULTING, it is just how it is. If someone is thinking about OD vs MD school, they need to consider what they will be able to do. If someone goes to dental school and decides, ya know I'dd rather do "input any medical speciality" they have to go to medical school. Now if any med school wants to comp OD's ~1 year of basic science I am fine with that.

I know how trained you guys are and am fine with expansion for everything except surgery, the reason why is you get trained in it. You are not trained in surgery and again there is no reason to. There is NO NEED for it. Do you think opticians should be able to refract, or even do basic eye exams?? Just like OMD's don't think OD's should do surgery. It's all about money, well in some ways yes, we are all protecting our "turf" that we worked very hard to get. You 4-5 years, me 8-10. Either way it doesn't matter, we both worked hard. Be proud of who you are. You went to OD school, protect that. I went to MD school and I'll protect that. If joe blow wants to start dispensing glasses, I guess opticians will protect their turf.

And lastly your training when it comes to surgery IS our business because it is what we do.

Good post.

Extremely balanced, to being almost favorable for ODs (short of being in favor of surgery).

 

[KHE]

If you think doing surgery will "legitimize" ODs in the mind of MDs you are mistaken. It is likely not about an OD's skill, it has more to do with throwing a bone to someone you stayed up with all night during your 3rd year of med school admitting patients with CHF, COPD, liver failure, blunt trauma,etc... People who can relate to your shared experience. In the past you have stated ODs should refer to ODs. How is this any different? While I don't disagree that an OD could easily say a newly diagnosed diabetic doesn't have NPDR, why would I tell a local FP MD that when someone like yourself always says "if you are not comfortable handling something refer to another OD first not an OMD".

I agree that doing surgery will not legitimize optometry in the eyes of MDs. I have worked in a medical school training ophthalmologists and I have also worked with ophthalmology residents as part of IHS. My experience has been that the issue isn't "throwing a bone, or staying up late" per se. The issue is that as part of their training, a FP doc, or an IM doc is going to work with every possible specialty, including podiatry and dentistry. However, they are likely to never encounter an optometrist, or an optometry student as part of their schooling. This is the fault of optometric education, not the medical establishment. The fact is that optometry is not, and has not historically been integrated into the health care delivery team well. Optometry has always operated "on the outside." Even though optometry is good at what it does, most MDs never really get to see it. Then, when you add on top of that med students who do a 6 week rotation through ophthalmology and are slammed with the notion that if you so much as even THINK about referring ANY sort of eye condition AT ALL to an optometrist that you will be IMMEDIATELY SUED UP THE WAZZZOOOOOOOO, it doesn't take much to figure out that primary care medicine is not going to see the optometrist as a viable referral option. I can't say I blame them.

 

[MR1]

The fact is that optometry is not, and has not historically been integrated into the health care delivery team well. Optometry has always operated "on the outside." Even though optometry is good at what it does, most MDs never really get to see it. Then, when you add on top of that med students who do a 6 week rotation through ophthalmology and are slammed with the notion that if you so much as even THINK about referring ANY sort of eye condition AT ALL to an optometrist that you will be IMMEDIATELY SUED UP THE WAZZZOOOOOOOO, it doesn't take much to figure out that primary care medicine is not going to see the optometrist as a viable referral option. I can't say I blame them.

This I have no idea how to fix, especially when (no kidding) I have had 2 residents, one med/peds and one IM, say to me they didn't know ophthalmology was a MEDICAL speciality until intern year.

Maybe OD's should appeal to Internists and Family docs in their communities and explain to them their training and limitations. I have heard of OMD's taking the OD's in town out for dinner when they set up practice, why not do the opposite. Also tell your patients that you are seeing for just a routine exam to come to you first with any eye problem. I'd much rather hear from an OD when I am on call about someone's eye I need to evaluate

The problem is almost NO ONE except us understands the difference b\w the 2 professions. Lastly KHE I disagree, I have spent a lot of time with many different OMD's as a MS3, 4, and intern and have never heard OD's bashed in that way. Now not to say the surgical debate wasn't discussed at times

 

[KHE]

This I have no idea how to fix, especially when (no kidding) I have had 2 residents, one med/peds and one IM, say to me they didn't know ophthalmology was a MEDICAL speciality until intern year.

As an optometrist, I don't know if that makes me feel better or worse.

Maybe OD's should appeal to Internists and Family docs in their communities and explain to them their training and limitations. I have heard of OMD's taking the OD's in town out for dinner when they set up practice, why not do the opposite. Also tell your patients that you are seeing for just a routine exam to come to you first with any eye problem. I'd much rather hear from an OD when I am on call about someone's eye I need to evaluate.

I think that in order for this to be viable, optometry on the whole would need some sort of third party endorsement from ophthalmology, which at this point in time is probably not likely.

Lastly KHE I disagree, I have spent a lot of time with many different OMD's as a MS3, 4, and intern and have never heard OD's bashed in that way. Now not to say the surgical debate wasn't discussed at times

Well, that's encouraging to hear and I hope that that is a trend that continues. My experience has been different, but times change. I know that we are starting to see more and more optometrists on staff at medical centers, and more and more they are not part of the ophthalmology department. This is probably going to be a good thing in the long run.

I oppose optometric surgery for many reasons, but at it's core I think that a big mistake that those who push for surgery are making is that I believe in the long run it is not going to be good for optometry to become more "like them."

 

[IndianaOD]

It isn't INSULTING, it is just how it is. If someone is thinking about OD vs MD school, they need to consider what they will be able to do. If someone goes to dental school and decides, ya know I'dd rather do "input any medical speciality" they have to go to medical school. Now if any med school wants to comp OD's ~1 year of basic science I am fine with that.

I know how trained you guys are and am fine with expansion for everything except surgery, the reason why is you get trained in it. You are not trained in surgery and again there is no reason to. There is NO NEED for it. Do you think opticians should be able to refract, or even do basic eye exams?? Just like OMD's don't think OD's should do surgery. It's all about money, well in some ways yes, we are all protecting our "turf" that we worked very hard to get. You 4-5 years, me 8-10. Either way it doesn't matter, we both worked hard. Be proud of who you are. You went to OD school, protect that. I went to MD school and I'll protect that. If joe blow wants to start dispensing glasses, I guess opticians will protect their turf.

And lastly your training when it comes to surgery IS our business because it is what we do.

If an optician wants to refract they can go to OD school. There is no run around here. In OD school you learn about the eye. Thus an optician that wants to refract will have the same schooling as any other OD and have no wasted time. An OD who wants to do eye surgery has to have 4 years MORE education than an OMD minimum.

I couldn't imagine having to re-peat all the main eye science stuff, sitting there twiddling your thumbs as the 1st year ophthos try to figure out how to use a BIO.

Hey if they keep opening these stupid OD schools, there will be more and more pressure to expand. Its bad for everyone.

 

[qwopty99]

If an optician wants to refract they can go to OD school. There is no run around here. In OD school you learn about the eye. Thus an optician that wants to refract will have the same schooling as any other OD and have no wasted time. An OD who wants to do eye surgery has to have 4 years MORE education than an OMD minimum.

I couldn't imagine having to re-peat all the main eye science stuff, sitting there twiddling your thumbs as the 1st year ophthos try to figure out how to use a BIO.

Hey if they keep opening these stupid OD schools, there will be more and more pressure to expand. Its bad for everyone.

I think some opticians will claim they have to re-learn optics, and they certainly will have to sit around "twiddling" their thumbs as opt students figure out how to edge lenses.

Also, many optician schools now include refraction as part of their curriculum.

I'm not saying I'm in favor of optician refraction, but you are making arguments for OD scope expansion, while denying the same type of arguments that opticians would use to expand their scope. That's not exactly fair.

 

[still_confused]

opticians do not need to take the dispensing classes at my school.

 

[IndianaOD]

I think some opticians will claim they have to re-learn optics, and they certainly will have to sit around "twiddling" their thumbs as opt students figure out how to edge lenses.

Also, many optician schools now include refraction as part of their curriculum.

I'm not saying I'm in favor of optician refraction, but you are making arguments for OD scope expansion, while denying the same type of arguments that opticians would use to expand their scope. That's not exactly fair.

Are you saying a couple credit hours is the same as 4 years. I don't recall spending a ton of time edging lenses.

 

[qwopty99]

Sure. You're right. ODs go through vast (vast) more amounts of training than do opticians. But doesn't it come across as somewhat hypocritical for ODs to dismiss all claims opticians have for wanting refraction, while saying optometrists have a meaningful claim to surgery?

If an MD wrote,

If an optometrist wants to do surgery they can go to MD school.

would you not find that insulting? Yet it is fair and reasonable for you to state,

If an optician wants to refract they can go to OD school.

Again, I'm not "disagreeing" with you per se, but I think it's a stretch to suggest the two are not slightly analogous.

 

[VA Hopeful Dr]

Are you saying a couple credit hours is the same as 4 years. I don't recall spending a ton of time edging lenses.

OK then, let the opticians open their own eye school, separate from optometry, available after they finish optician school. They can skip optics and refraction (and maybe basic CL, I don't know how much they know on that one), make it a 3 year program and then they come out as medical opticians.

 

[qwopty99]

opticians do not need to take the dispensing classes at my school.

What does this mean? Your school offers opticianry? (what school is that?) Or you're saying opticians don't have to learn dispensing (??).

 

[qwopty99]

I'm just going to say that it's probably a good thing that we are conducting this optometry-surgery discussion here in the optometry forum rather than in the ophthalmology forum.

It seems this topic is just too sensitive/confrontational to not cause a flame war over there (I'm not one to avoid controversial topics, but even_I_never had the stomach to start this thread), so its probably best that it gets discussed here in "our" backyard.

 

[still_confused]

What does this mean? Your school offers opticianry? (what school is that?) Or you're saying opticians don't have to learn dispensing (??).

Opticians that are currently studying to become optometrists do not need to take the dispensing course in the OD program.

 

[Oculomotor]

I think KHE makes good points and his experience in the field is invaluable but I disagree. There are students (in my class) who would jump at the opportunity to have additional training at the end of OD school. The difficulty and rigor of our optometry, medical , and dental programs is very similar and any opinion to the contrary is ludicras. Optometric education could be modified in the 3rd year for "students on a surgery tract" by adding 6 months of selective rotations (ex. internal medicine, emergency medicine, anesthesia, ophthalmology) like a month each along with some "surgical training" it definitely COULD be done. Then they would do a 3-4 yr (for example) surgery residency..The rest of the 95%+ of students just continue in the regular OD (primary eye doctor) pathway. I feel that we need to stop using the "market need", the "we have always done things this way", attitudes and be proactive instead. In 1971 there were OD's opposed to getting pharmaceutical agents (history is repeating itself!!!) And as an optometry student now and an OD in the future I would feel deeply insulted if I wanted to perform ocular surgery in the future and I would have to go back to "professional school" and earn another degree (MD, DO.)? That is basically denegrating and disrespecting my OD degree. I would NEVER do that even if I wanted too!!!!! This is the last degree I am going to pursue---I study 40-50 hours a week outside of class, I have gained 6 pounds, and I sleep an average of 4-5 hours a night, 4 years of this is enough! I just want to have the ability in the next 10-15 yrs to do periocular injections, chelazion removal, superficial lesion removal, superficial anterior segment lasers procedures, with additional training (not another degree! LOL). That is just my take on that.....

thanks to everyone for keeping the thread professional......

 

[IndianaOD]

OK then, let the opticians open their own eye school, separate from optometry, available after they finish optician school. They can skip optics and refraction (and maybe basic CL, I don't know how much they know on that one), make it a 3 year program and then they come out as medical opticians.

Make it at least 3.5 years and that's fine. Its no different than having another OD school, which there seems no end to.

 

[KHE]

I think KHE makes good points and his experience in the field is invaluable but I disagree. There are students (in my class) who would jump at the opportunity to have additional training at the end of OD school.

Those people should have gone to medical school. I know that that is the standard glib response, but why would those students enroll in optometry school? Did they not know what optometry was or what optometrists did on a day to day basis?

The difficulty and rigor of our optometry, medical , and dental programs is very similar and any opinion to the contrary is ludicras. Optometric education could be modified in the 3rd year for "students on a surgery tract" by adding 6 months of selective rotations (ex. internal medicine, emergency medicine, anesthesia, ophthalmology) like a month each along with some "surgical training" it definitely COULD be done. Then they would do a 3-4 yr (for example) surgery residency..The rest of the 95%+ of students just continue in the regular OD (primary eye doctor) pathway.

These statements always puzzle me. What are you basing that on? In what way do you know, or are you qualified to assess what type of knowledge one needs to be a competent eye surgeon? How do you know that "6 months of selective rotations" is what is needed to prepare someone for the study of surgery?

I feel that we need to stop using the "market need", the "we have always done things this way", attitudes and be proactive instead. In 1971 there were OD's opposed to getting pharmaceutical agents (history is repeating itself!!!)

Big big difference here. There was a demand for patients needed topical therapy and those patients were being referred to primary care doctors for treatment even though the OD was more than capable, and in many cases MORE capable of handing the problem. Even the most militant of ophthalmologists out there doesn't want their waiting room clogged with patients needed Pataday refills. However, there is no demand or need for optometric surgery. To ignore the market realities of that simply puts those students who were to train in that way at risk. They are going to graduate from their optometric surgery training programs and find that they simply don't have any patients to operate on. Not only is that going to embitter them, it's going to erode whatevery skills in surgery they aquired. Simply put, there is no part of the country that is underserved with repect to ophthalmic surgery, and even if you could find a tiny pocket here and there in the corners of some remote state, there is simply little or no likelihood that any future optometric surgeon will practice there.

And as an optometry student now and an OD in the future I would feel deeply insulted if I wanted to perform ocular surgery in the future and I would have to go back to "professional school" and earn another degree (MD, DO.)? That is basically denegrating and disrespecting my OD degree.

I disagree with that as well. Your degree trains you to be an optometrist, not a surgeon. There is nothing wrong with that. There is no reason to be insulted any more than you would be insulted by having to go back to school to get a law degree if that is what you so desired.

I would NEVER do that even if I wanted too!!!!! This is the last degree I am going to pursue---I study 40-50 hours a week outside of class, I have gained 6 pounds, and I sleep an average of 4-5 hours a night, 4 years of this is enough! I just want to have the ability in the next 10-15 yrs to do periocular injections, chelazion removal, superficial lesion removal, superficial anterior segment lasers procedures, with additional training (not another degree! LOL). That is just my take on that.....

Other than chalazion removals you are going to find that 99.99% of optometric practices simply do not have the volume of those other types of surgical cases you mentioned.

 

[KHE]

Sure. You're right. ODs go through vast (vast) more amounts of training than do opticians. But doesn't it come across as somewhat hypocritical for ODs to dismiss all claims opticians have for wanting refraction, while saying optometrists have a meaningful claim to surgery?

If an MD wrote,

If an optometrist wants to do surgery they can go to MD school.

would you not find that insulting? Yet it is fair and reasonable for you to state,




Again, I'm not "disagreeing" with you per se, but I think it's a stretch to suggest the two are not slightly analogous.

I don't think you can make that leap.

Yes, opticians can be trained to perform refractions as well as any OD. There is nothing magical or mystical about the art of refraction. However, the difference here is that ODs are trained to assess the health of the eye to ensure that where that reduced vision is coming from, and always have been even if they may not have been licensed to treat whatever it was they found. Opticians are not.

It is far more risky to the health of the public to have opticians refracting independently than it was for optometrists to be using tropicamide.