Dang it, vacation

[IndianaOD]

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Gone for a couple of weeks and interesting crap goes on. Who closed the surgery thread? These topics always come around, just leave it open. Start a pro OD, anti OMD thread that is stickied like the OMDs have.

I would have loved to respond to some of that MD-in-training rhetoric.

 

[VA Hopeful Dr]

Gone for a couple of weeks and interesting crap goes on. Who closed the surgery thread? These topics always come around, just leave it open. Start a pro OD, anti OMD thread that is stickied like the OMDs have.

I would have loved to respond to some of that MD-in-training rhetoric.

It got closed because of gochi and qwopty basically turned it into the internet equivalent of a 10 year old girl fight. Had they not been around, I think the thread had real promise; it was one of the most civilized threads of that sort I've seen.

Maybe we can start a thread where after X number of just completely useless posts, a person gets disallowed from posting there again. It would also work against the useless pro-MD folks who offer no real thoughts other than "med school is the only surgery route" without any arguments as to why that is.

Just a thought.

 

[IndianaOD]

I definitely up for honest debate. As long as its agreed that the friction is all about money and ridiculous pride.

I'm tired of OD students telling MD students they don't know crap. I'm also VERY tired of the other way.

I'm tired of MD interns and residents babbling on about ODs don't have to do 1000 hours a week in the hospital. WHO CARES? Being able to deliver a baby or putting everyone on a Statin doesn't mean anything concerning eye care. Heck, med school could be 20 years long and if there still isn't any eye training it won't make you any better of an EYE doctor.

A general OMD has 2 or 3 years of extra total education over a residency trained OD and makes on average 3x + what an OD makes. So 21 years of school compared to 23? That's a pretty good payoff ratio.

 

[VA Hopeful Dr]

I definitely up for honest debate. As long as its agreed that the friction is all about money and ridiculous pride.

I'm tired of OD students telling MD students they don't know crap. I'm also VERY tired of the other way.

I'm tired of MD interns and residents babbling on about ODs don't have to do 1000 hours a week in the hospital. WHO CARES? Being able to deliver a baby or putting everyone on a Statin doesn't mean anything concerning eye care. Heck, med school could be 20 years long and if there still isn't any eye training it won't make you any better of an EYE doctor.

A general OMD has 2 or 3 years of extra total education over a residency trained OD and makes on average 3x + what an OD makes. So 21 years of school compared to 23? That's a pretty good payoff ratio.

Of course its about money and pride (or respect, if you believe the other thread); however, there is also the simple truth that as of right now, OD schools don't provide, on an equal basis from school to school, the training y'all need to do much past what y'all are allowed to do in the more liberal states (ignoring OK and throwing in perhaps chalazions, that's outside my knowledge). Could ODs be trained up to do more, sure. I'm just not sure you are there yet. KHE had a great post in the other thread about this - LASIK complications being the centerpiece.

I'm somewhat inclined to listen to Caffeinated when he espouses the importance and applicability of med school when it comes to ophthalmology - he also had a good post in the other thread. Obviously I can't speak from experience, nor will I ever be able to, but he seems to know what's going on and isn't rabidly anti-optometry.

Ophthalmologists also only have 1 year over the primary care medical specialties, and tend to make 2X as much (or can, with a good referral base). Until Medicare places value on decision making and not just on procedures, that's just the way things are. So for what its worth, y'all are in the same boat as the family practice guy down the street.

I think we could, maybe, turn this thread into a decent place to debate these things. We'll just need a mod on board early on to keep things on topic (read: no pre-anythings and definitely keeping a closer eye on med/opt students).

 

[IndianaOD]

I agree with the PCP comparison. In fact, I was sitting next to a recently retired exec from a large (100+ MD multi-specialty group) while at a show on said vacation. He brought up the same exact point, saying it doesn't make sense to get paid 2x as much just because you do procedures. In his case he didn't think it fair that the internal medicine docs got paid so much less than many of the other "niche" MDs.

The income should compensate for higher insurance premiums, but little else.

On another note, have you ever thought about PRK? Many OMDs are switching back to this procedure due to the increased scrutiny on LASIK. I can already debride the cornea for recurrent errosions etc, the only real difference is then applying a laser.

No button holes or dislocated flaps.

I think the other conversation assumed extra years of training. Truthfully I don't care about surgery, I would just like what I do to be fairly reimbursed. For example, why can an OT bill medical insurance for therapy, but ODs can't bill for vision therapy (which has MUCH more scientific evidence behind it).

 

[VA Hopeful Dr]

I agree with the PCP comparison. In fact, I was sitting next to a recently retired exec from a large (100+ MD multi-specialty group) while at a show on said vacation. He brought up the same exact point, saying it doesn't make sense to get paid 2x as much just because you do procedures. In his case he didn't think it fair that the internal medicine docs got paid so much less than many of the other "niche" MDs.

The income should compensate for higher insurance premiums, but little else.

On another note, have you ever thought about PRK? Many OMDs are switching back to this procedure due to the increased scrutiny on LASIK. I can already debride the cornea for recurrent errosions etc, the only real difference is then applying a laser.

No button holes or dislocated flaps.

I think the other conversation assumed extra years of training. Truthfully I don't care about surgery, I would just like what I do to be fairly reimbursed. For example, why can an OT bill medical insurance for therapy, but ODs can't bill for vision therapy (which has MUCH more scientific evidence behind it).

I don't know much about PRK, so I'll leave that to the more qualified souls.

I will agree 100% about fair reimbursements. I remember working insurance for an OD office and not comprehending why there were so many insurance plans that we couldn't accept. That, however, can be fixed in the legislature - AWP and all of that. It shouldn't have to be that way, but it is and I'm not sure how you'd fix it short of laws like AWP.

Like PRK, I know very little about OT so I'll defer on that. Given that you did your residency in VT, I hesitate to say this, but I haven't seen many, if any, really good studies on the subject. Over on ODWire every time VT's big champion brings it up, he often gets stomped back down. The studies he produces, while promising, aren't good enough to really incorporate it into main stream medicine. If I'm wrong, please show me the studies saying otherwise. I do find VT fascinating, I'm still just a touch skeptical.

 

[IndianaOD]

I don't know much about PRK, so I'll leave that to the more qualified souls.

I will agree 100% about fair reimbursements. I remember working insurance for an OD office and not comprehending why there were so many insurance plans that we couldn't accept. That, however, can be fixed in the legislature - AWP and all of that. It shouldn't have to be that way, but it is and I'm not sure how you'd fix it short of laws like AWP.

Like PRK, I know very little about OT so I'll defer on that. Given that you did your residency in VT, I hesitate to say this, but I haven't seen many, if any, really good studies on the subject. Over on ODWire every time VT's big champion brings it up, he often gets stomped back down. The studies he produces, while promising, aren't good enough to really incorporate it into main stream medicine. If I'm wrong, please show me the studies saying otherwise. I do find VT fascinating, I'm still just a touch skeptical.

Start with the CITT trials (Convergence Insufficiency Tx Trial). The OTs work is far more difficult to prove.

In fact VT is more effective than surgery for many eye turns. Cover up the non-deviating eye and I bet you it will happily go to all positions of gaze. Its not a muscle problem, its a neurological problem....the reason many patients go through multiple strabismus surgeries.

 

[IndianaOD]

[FONT=TimesNewRoman,Italic]

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.

 

[IndianaOD]

Any questions, there is even more out there than this. I could bet you can't find near this amount of publication on many medical threatment theories.

 

[VA Hopeful Dr]

Any questions, there is even more out there than this. I could bet you can't find near this amount of publication on many medical threatment theories.

You'll have to forgive me, exams started this week so I won't be able to even look at most of those until next Friday. I'm also somewhat worried that I won't be able to get full text on most of those - I doubt Optometry journals are kept at the medical library, but I'll figure that out in 2 weeks.

Either way, I haven't forgotten this; just don't have the time right now to properly go through all of those.

 

[IndianaOD]

You'll have to forgive me, exams started this week so I won't be able to even look at most of those until next Friday. I'm also somewhat worried that I won't be able to get full text on most of those - I doubt Optometry journals are kept at the medical library, but I'll figure that out in 2 weeks.

Either way, I haven't forgotten this; just don't have the time right now to properly go through all of those.

There are some newer review articles out there if you like. The CITT trials are available for free. Just google it.

 

[VA Hopeful Dr]

There are some newer review articles out there if you like. The CITT trials are available for free. Just google it.

OK, finals are done so I've had time to look over this stuff.

On the large list you gave a few posts back, all of the new studies are in optometry journals (which I have no access to) and the studies in medical journals are almost universally older than 1975 (which we have no holdings for). I'll have to rely on others to discuss those.

As for the CITI trial, from what little I understood it does look promising. I would have preferred a larger sample size, but that can easily be done in future work. One thing I did wonder about was the difference between the pencil group and the VT group. The latter got an hour of doctor time per week, the former was entirely home stuff. I'm not sure how to control for this, but I do wonder if it might make a difference.

 

[IndianaOD]

OK, finals are done so I've had time to look over this stuff.

On the large list you gave a few posts back, all of the new studies are in optometry journals (which I have no access to) and the studies in medical journals are almost universally older than 1975 (which we have no holdings for). I'll have to rely on others to discuss those.

As for the CITI trial, from what little I understood it does look promising. I would have preferred a larger sample size, but that can easily be done in future work. One thing I did wonder about was the difference between the pencil group and the VT group. The latter got an hour of doctor time per week, the former was entirely home stuff. I'm not sure how to control for this, but I do wonder if it might make a difference.

You have to understand that the politics of ophthalmology is why most of it is in OD journals. The methods are just as valid.

 

[VA Hopeful Dr]

You have to understand that the politics of ophthalmology is why most of it is in OD journals. The methods are just as valid.

I'm not implying anything negative in saying most of the studies were in OD journals. I was just saying that because of that fact I cannot get access to read the articles.

 

[still_confused]

I'm not implying anything negative in saying most of the studies were in OD journals. I was just saying that because of that fact I cannot get access to read the articles.

Check bigger university libraries, they usually buy access to almost every journal ever in existence.

 

[IndianaOD]

I'm not implying anything negative in saying most of the studies were in OD journals. I was just saying that because of that fact I cannot get access to read the articles.

Any decent med school should have electronic access to all the journals. I know the IU med school does.

 

[VA Hopeful Dr]

Check bigger university libraries, they usually buy access to almost every journal ever in existence.

True to an extent. I'll go through the different journals listed above and tell you which ones we have and from there why I haven't read the article in question. As a side note, we're the biggest university in the state and our library is indexed with the other med school in the state.

Experimental Neuro - Electronic from 2000, I don't care enough to track down the print holdings in person.
Archives of Opth. - Even our print holdings don't go back to the 1950s article posted above.
Am. J. Optom. Physiol. Opt. - We don't have it and neither does the other med school in the state.
Optometry and Vision Science - No print, online from 2000.
J. of the Amer. Optom. Association - No holdings in either school.
Am. J. of Ophth. - Obviously have, but only from 1966 on.
British J. of Ophth - Neither school has
British Orthop. J. - Same
Acta Ophth. - No holdings as early as the 1950s

Basically, we have about half of the OD journals mentioned but only in online form which restricts us to post 1996ish. We have no journals before 1960 to speak of. We have about half of the books listed, but again VT just isn't important enough to me to justify that kind of effort.

Any decent med school should have electronic access to all the journals. I know the IU med school does.

Backhanded comment aside, I bet IU has better holdings since, last I checked, there was an OD school and a med school in the IU system. Just for fun I checked both UNC and Duke since they are both pretty large universities and med schools. Neither had Am. J. Optom. Physiol. Opt. or J. of the Amer. Optom. Association in their online holdings (which typically means nothing in print either).

I don't know why this is such a shock to either of you - I bet there's plenty of medical journals that I have access to that OD students at schools not affiliated with a medical school don't have access to.

 

[still_confused]

I don't know why this is such a shock to either of you - I bet there's plenty of medical journals that I have access to that OD students at schools not affiliated with a medical school don't have access to.

Its not a shock to me, I was just giving a suggestion. Our school has subscription to SI, and thats all I really care about anyway.

And really, you probably have better things to do...go out and party instead of tracking down VT articles.

 

[IndianaOD]

Its not a shock to me, I was just giving a suggestion. Our school has subscription to SI, and thats all I really care about anyway.

And really, you probably have better things to do...go out and party instead of tracking down VT articles.

I compliment the dedication tough I wouldn't spend a lot of time on it unless you are really interested. If so I'll try to find some more recent review papers for you.

 

[VA Hopeful Dr]

I compliment the dedication tough I wouldn't spend a lot of time on it unless you are really interested. If so I'll try to find some more recent review papers for you.

Sorry for the delay, way too many weddings in June to go to.

There is a major review of all VT research underway at the moment, but there's no telling when that will be finished. If its not too much trouble, I'd love to see a couple of recent review papers.