Dear Professional Colleagues...

[NEATOMD]

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Dear professional colleagues,
It often saddens me to see so many arguments on this forum between optometrist and M.D’s. While I realize I can’t end the problem, I will do my part to help. However, I am quite limited in my abilities since there appears to be an educational deficit present. By that statement, I simply mean that MD’s aren’t the slightest bit familiar with the OD curriculum and are not encouraged to be. We are often, however, familiar with the rhetoric that has been fed to us by organizations such as AMA and our state medical societies. When I went to my first AMA meeting to join, one of the organizations main points for why we should join was that the AMA has “successfully prevented prescribing powers to OD’s” and that through my support they could continue to fight against such “evils.” Well, anyway, I signed up for the AMA and paid my dues. The funny thing about it is that when I signed up, they gave me a free stethoscope and a Stedman’s, which I immediately gave to my identical twin brother who happens to be a second year Optometry student. What’s my point? Simply this: I’m familiar with both sides and I know what I’m talking about. So, read on…

I’ve heard fellow medical students complain about OD’s and their quest for “prescribing powers” and I’ve found that debating against them is really pointless since in most cases they don’t have ANY REAL understanding of the OD curriculum or practice. For instance, most MD’s don’t know that most OD’s take the exact same pharm. classes as they do (sometimes, from what I’ve seen OD pharm classes are harder). They also neglect the fact that in most states, OD’s have been safely prescribing orals without problems. But, if you still do not think it’s important for OD’s to have prescribing rights, then keep reading.

One day I called home to talk to my family and I mentioned the whole AMA thing to my dad (who is an OD.) He just laughed lightly and proceeded to tell me about a patient that had been referred to him by a family doc just that very week. Apparently, he took a look at the guys’ eyes and realized that the guy was developing a dendritic ulcer. But, since he’s an OD, he can’t prescribe the drug he knows the guy needs in this state. He, immediately calls around to schedule an appointment for the guy with an ophthalmologist, hoping one could see the guy that very day, since he realized how quickly the man’s vision could deteriorate. Unfortunately, the soonest was in two days. Within, those two days, the man’s vision went from 20/38 to 20/400. The good news is that the ophthalmologist confirmed the diagnosis and began successful treatment at that appointment (the same treatment my dad would have prescibed).

Here’s the moral of the story: It’s sad to think that if my dad could have given the medication that he knew the man needed, the guy wouldn’t have become legally blind. It’s even sadder that MD’s (and MD’s students) fight so hard to prevent OD’s from being able to prescribe oral medications while they proudly proclaim their credence, “Primum nun Cocere,” (first, do no harm). Something here makes me think we need a change. Somehow, I fail to see how insuring a paycheck for some ophthalmologist prevented harm to that man, who basically lost his vision. Luckily, with some monetary expense to that man, he may regain most of his vision back with treatment. What is more, this is not an isolated incident…similar cases appear to be common. It is sad to see so many disrespectful MD’s that refuse to see optometrists as anything more than “glorified tech’s”. Meanwhile, if you remember back to the story above, the family doc could not diagnose the disorder, while the optometrist could. Does this mean the FP didn’t do his job? No, actually, he did his job-> He properly referred the pt to an “Eye Doctor.”

Oh yeah, one more thing… from what I can tell, all that stuff about Med school being harder than optometry school is all bunk, its not harder, just different. My brother is just as smart as I am and could be going to school to be an MD if it were what he wanted to do…although, sometimes I even think he’s smarter than I am since he’s going to get paid similarly to myself without having to go through a residency first.

 

[Ryan_eyeball]

Dear professional colleagues,
It often saddens me to see so many arguments on this forum between optometrist and M.D’s. While I realize I can’t end the problem, I will do my part to help. However, I am quite limited in my abilities since there appears to be an educational deficit present. By that statement, I simply mean that MD’s aren’t the slightest bit familiar with the OD curriculum and are not encouraged to be. We are often, however, familiar with the rhetoric that has been fed to us by organizations such as AMA and our state medical societies. When I went to my first AMA meeting to join, one of the organizations main points for why we should join was that the AMA has “successfully prevented prescribing powers to OD’s” and that through my support they could continue to fight against such “evils.” Well, anyway, I signed up for the AMA and paid my dues. The funny thing about it is that when I signed up, they gave me a free stethoscope and a Stedman’s, which I immediately gave to my identical twin brother who happens to be a second year Optometry student. What’s my point? Simply this: I’m familiar with both sides and I know what I’m talking about. So, read on…

I’ve heard fellow medical students complain about OD’s and their quest for “prescribing powers” and I’ve found that debating against them is really pointless since in most cases they don’t have ANY REAL understanding of the OD curriculum or practice. For instance, most MD’s don’t know that most OD’s take the exact same pharm. classes as they do (sometimes, from what I’ve seen OD pharm classes are harder). They also neglect the fact that in most states, OD’s have been safely prescribing orals without problems. But, if you still do not think it’s important for OD’s to have prescribing rights, then keep reading.

One day I called home to talk to my family and I mentioned the whole AMA thing to my dad (who is an OD.) He just laughed lightly and proceeded to tell me about a patient that had been referred to him by a family doc just that very week. Apparently, he took a look at the guys’ eyes and realized that the guy was developing a dendritic ulcer. But, since he’s an OD, he can’t prescribe the drug he knows the guy needs in this state. He, immediately calls around to schedule an appointment for the guy with an ophthalmologist, hoping one could see the guy that very day, since he realized how quickly the man’s vision could deteriorate. Unfortunately, the soonest was in two days. Within, those two days, the man’s vision went from 20/38 to 20/400. The good news is that the ophthalmologist confirmed the diagnosis and began successful treatment at that appointment (the same treatment my dad would have prescibed).

Here’s the moral of the story: It’s sad to think that if my dad could have given the medication that he knew the man needed, the guy wouldn’t have become legally blind. It’s even sadder that MD’s (and MD’s students) fight so hard to prevent OD’s from being able to prescribe oral medications while they proudly proclaim their credence, “Primum nun Cocere,” (first, do no harm). Something here makes me think we need a change. Somehow, I fail to see how insuring a paycheck for some ophthalmologist prevented harm to that man, who basically lost his vision. Luckily, with some monetary expense to that man, he may regain most of his vision back with treatment. What is more, this is not an isolated incident…similar cases appear to be common. It is sad to see so many disrespectful MD’s that refuse to see optometrists as anything more than “glorified tech’s”. Meanwhile, if you remember back to the story above, the family doc could not diagnose the disorder, while the optometrist could. Does this mean the FP didn’t do his job? No, actually, he did his job-> He properly referred the pt to an “Eye Doctor.”

Oh yeah, one more thing… from what I can tell, all that stuff about Med school being harder than optometry school is all bunk, its not harder, just different. My brother is just as smart as I am and could be going to school to be an MD if it were what he wanted to do…although, sometimes I even think he’s smarter than I am since he’s going to get paid similarly to myself without having to go through a residency first.

Couldn't your dad have told the patient to go to a local hospital's emergency room for which I'm sure they might have been an ophthamology resident there? Of course, this could be a really small town also. Tough call.

Was just curious.

 

[NEATOMD]

Couldn't your dad have told the patient to go to a local hospital's emergency room for which I'm sure they might have been an ophthamology resident there? Of course, this could be a really small town also. Tough call.

Was just curious.

Yeah, its a medium/small community. There's a really nice hospital, but the E.R. docs most likely wouldn't have had a clue. So, I doubt they would have tried anything more than a topical since, they like the FP, wouldn't have realized the severity. Plus, if they couldn't diagnose, they probably wouldn't have even called the opthalmologist, but most likely they would have paged my dad's partner (an OD) if anything.

 

[still_confused]

thanks for your post.

i think most sane optometrist could care less about treading on opth territory or has delusions of being an medical doctor. i really believe that most ODs (at least the few i talked to and fellow pre opt students) do not want to do cataract surgery or any other complicated manuvers ( i leave refractive out because i do not understand it). what we strive for is what we were trained to do, be primary eye care professionals (doctors, techs, or whatever).

many of my friends wonder out loud, "why optometry? you can/should go to med school with me" and i spend the time to tell them my reasons and (at least i hope) they understand. when they realize that i was going to be an OD that doesnt stop them from asking me for help on homework sets or give them the superior aura when i ask them for help. if you personally know an OD and really talked to them, you will respect them for choosing thier own road.

you're understanding of the OD is excellent and i will respond with my own feelings towards MDs. The status is undeniable. charged with saving lives and dealing with the most complicated problems along with the stress of work and thier personal lives, i am amazed on how they keep it together. noone will claim that MDs (and DOs) are not important. healthcare is a team effort, from the doctors to nurses to other staff, it requires each level to do what they do best to ensure the health of thier patient.

i may be a kid, but should i attend and complete my OD education, i will continue to ensure that ODs only perform procedures that they are trained (and trained well) to do, as well as ensuring that we never take on a case that we are not equip to handle.

most, if not all on this OD board are sane and understanding. we only began throwing random insults when someone calls us as glorified opt techs, instead of by what we work so hard to obtain. as difficult as it is for some to believe, we study hard everyday in hopes of providing the best care possible.

ods are not the enemies of mds, we are there to help. i hope someday we may all exist in harmony 🙂

so i tip my hat to you neatomd and hope your patients know how lucky they are to have a doctor that not only knows his own field well, but other fields as well.

 

[ituryu]

thanks for your post.

i think most sane optometrist could care less about treading on opth territory or has delusions of being an medical doctor. i really believe that most ODs (at least the few i talked to and fellow pre opt students) do not want to do cataract surgery or any other complicated manuvers ( i leave refractive out because i do not understand it). what we strive for is what we were trained to do, be primary eye care professionals (doctors, techs, or whatever).

many of my friends wonder out loud, "why optometry? you can/should go to med school with me" and i spend the time to tell them my reasons and (at least i hope) they understand. when they realize that i was going to be an OD that doesnt stop them from asking me for help on homework sets or give them the superior aura when i ask them for help. if you personally know an OD and really talked to them, you will respect them for choosing thier own road.

you're understanding of the OD is excellent and i will respond with my own feelings towards MDs. The status is undeniable. charged with saving lives and dealing with the most complicated problems along with the stress of work and thier personal lives, i am amazed on how they keep it together. noone will claim that MDs (and DOs) are not important. healthcare is a team effort, from the doctors to nurses to other staff, it requires each level to do what they do best to ensure the health of thier patient.

i may be a kid, but should i attend and complete my OD education, i will continue to ensure that ODs only perform procedures that they are trained (and trained well) to do, as well as ensuring that we never take on a case that we are not equip to handle.

most, if not all on this OD board are sane and understanding. we only began throwing random insults when someone calls us as glorified opt techs, instead of by what we work so hard to obtain. as difficult as it is for some to believe, we study hard everyday in hopes of providing the best care possible.

ods are not the enemies of mds, we are there to help. i hope someday we may all exist in harmony 🙂

so i tip my hat to you neatomd and hope your patients know how lucky they are to have a doctor that not only knows his own field well, but other fields as well.

I strongly agree with what you've said and thumbs up.

 

[cpw]

I ran into something similar a few saturdays ago when I had a patient with pre-septal cellulitis. In my state (Florida) I have no oral Rx rights.. when I did in Texas. Apparently as soon as I crossed state lines I became a *****. But I digress.....

It took me six phone calls to different offices and THREE hours before I could get an OMD to call me back (remember, it was a Saturday)... even though all my messages said I had a patient who needed IMMEDIATE oral Abx. (which I easily could/should have started her on myself) The next appointment I could get her in for was 6pm THE NEXT DAY! Fortunately I got hold of a doc who would call something in for her before her appointment.. thank god he trusted me that much. But, I felt really horrid the poor patient was sitting in my office for three hours waiting for them to get ahold of me. (she had no cell for me to reach her at and didn't want to drive all the way home)

Stupid state laws...

 

[Richard_Hom]

Dear NEATOMD,

Your sentiments are to be commended but hides the conflict that is underlying optometry and organized medicine.

There is a growing trend in reimbursement to deny optometrists or optometric patients reimbursement for procedures and medications if done by the optometrists.

I think the sentiment you portray regarding comraderie is all well and good, but when the 'chips are down" what will the 'friends of optometry" in medicine do? Will they recognize and acknowledge the excellent clinical care they give to their patients and help optometry regain parity in third part reimbursement?

After many, many years in practice, it is easy for medical friends to give you that glow of well-being by saying a few good words, but I like to see more "meat".

Would you be willing to help optometry in this circumstance?

Richard_Hom

 

[KHE]

I ran into something similar a few saturdays ago when I had a patient with pre-septal cellulitis. In my state (Florida) I have no oral Rx rights.. when I did in Texas. Apparently as soon as I crossed state lines I became a *****. But I digress.....

It took me six phone calls to different offices and THREE hours before I could get an OMD to call me back (remember, it was a Saturday)... even though all my messages said I had a patient who needed IMMEDIATE oral Abx. (which I easily could/should have started her on myself) The next appointment I could get her in for was 6pm THE NEXT DAY! Fortunately I got hold of a doc who would call something in for her before her appointment.. thank god he trusted me that much. But, I felt really horrid the poor patient was sitting in my office for three hours waiting for them to get ahold of me. (she had no cell for me to reach her at and didn't want to drive all the way home)

Stupid state laws...

Your patient should document her experience in a letter to every state legislator that she possibly can. That's the only way laws like that are going to change.

 

[3eb4me]

Your patient should document her experience in a letter to every state legislator that she possibly can. That's the only way laws like that are going to change.

You might want to donate a pack of stamps. Try emailing also. I remember emailing my state reps for gun control on campus, and I actually got a response.

 

[Tom_Stickel]

Neato,

As an "I could have gone to med school but didn't want to" OD with a wife in med school, I can tell you that on average I do believe med school to be harder than optometry school.

Granted, my wife goes to a top 3 med school in the country, but I went to a "top" OD program at IU. The anatomy in med school ismuch more grueling, the pharm and physio is more comprehensive and systemic, and so is the path. Ocular disease is a difficult subject, but I can't say it's any harder than the kidney block in 2nd year med school.

Then there's third year. There's no way to compare the amount of info that must be crammed into your head and the long, painful hours of third year med school to anything in Optometry school. Even if you're going to forget vast amounts of systemic medicine during your ophtho residency, you still have to learn enough for shelfs/boards/etc.

This is not to say that Optometry school is easy, because it's not. Also, I'm only familiar with the demanding curriculum at a med school with an average MCAT in the mid 30s. Maybe at your smaller med schools it is more comparable to the curriculum at IU or Berkeley. But for ODs to say our school is just as hard as med school seems a bit of ego stroking...

All that being said, every day that goes by makes me happier and happier I went the route I did. Heck, even my wife looks at about once a week and wishes she had gone to optometry school and just avoided all the scut work 😉

Tom Stickel

p.s. I agree with Richard about reimbursements. As they say in journalism, "Follow the money"

 

[rpie]

Neto, I agree, OD and MD schools are different. I found he difficulty of medical school the same as OD school. Yes, some of the basic sciences are taught more in-depth especially the anatomy but nothing an OD student couldn’t handle. If you’re talking about the demand, the physical and mental demand was greater for medicine, especially in the 3rd and 4th year. Being on call every 3rd day and then having to attend classes was very challenging.

 

[gsinccom]

would you say then that the 1st and 2nd years ( of MD & OD) are equally challenging? it seems from most opinions and research I've done that even though the credit hour load at opt schools the 1st and 2nd years is about the same as med schools that all in all those first two years towards an MD are more challenging/time consuming than those 1st two years towards an OD degree. one comment - the 4th year of MD is easy compared to the 1st and 2nd and 3rd especially(from all of my MD friends opinions...most of whom are just starting their residencies)...it is the 3rd year that is the killer.
I guess the best question would be to ask 4th year OD students and those that have just graduated in the past few years whether they would advise aganist the OD path. I've heard of many that have gone the md path that actually advise against it. many of them still plan to continue and want to be md doctors but feel like the hassels to get there aren't worth it. (check out all the stuff here on studentdoctor.net on the med students forum and med students residency forum). what do ods think about their own situation?
later

 

[Hines302]

I guess the best question would be to ask 4th year OD students and those that have just graduated in the past few years whether they would advise aganist the OD path. I've heard of many that have gone the md path that actually advise against it.

Wow, you have just opened up another can of worms with that question. Please lets not get into another OD bashing session here. Cause thats what they always seem to turn into

 

[gsinccom]

that wasn't my intention. please read my comments carefully. (more background: I was orginally a pre-md, desiring a primary care specialty, student but decided it wasn't worth it.) (I am starting to think that the road to be an optometrist isn't as bad and might just be worth it.) thank you.

 

[Hines302]

Oh no... I know it wasn't your attention. I made that statement just so other people would respond with helpful information, not with OD critisim. This topic has been discussed a lot in previous threads, it may people helpful to look back at these as well.

I am a 4th year undergrad student, and was in your situation as well. I decided against medicine and for optometry. Several reasons for this:

1. Is a optometrist really that much different from a family doctor? Both are primary care, and both will only handle the basics until it becomes beyound there scope for practice. (on a side note, OD's are begining to manage and co-manage more Dx's than ever before).

2. Legnth of Schooling. (However I still wish to pursue and optometry residency and or an MS of PhD after optometry school)

3. Although it may be more difficult to earn the same amount of money as a family doctor (depending on the practice).... it is still possible. I have worked and heard of OD's making (take home) well over 200K a year (in a joint practice w/ other OD's).

4. I didnt want to sepnd 7 years to become a family doctor to do what a family doctor does. For example, having to give a physical... and everything that entials. (ie. sticking my fingure up some old guys behind) I'll stick to looking at the eyes.

5. OD's (or at least the ones I have worked with, including my own) are so friendly, and have time to sit and talk to the patient. Family Doctors, or any other type, are always rushed in and out of the room, never having the time to talk. Conversations between Dentist and patients are always kind of one sided as well.

These are just come of the reason I choose optometry, and I am very happy with my choice. I am currently doing interviews and hope to attend a school next fall.

 

[gsinccom]

hines302,

those are similar conclusions I've come to.
some of my observations would be that opt school isn't as time consuming as med school. The 1st and 2nd years are close to comparable but med is still harder. 3rd year isn't even a comparrison with med being way more time consuming. 4th year opt might actually be tougher than 4th year med from what my MD friends have told me...but it'll certainly be better than the 1st 3 years of Opt or Med. Opts of course aren't trained as thoroughly as primary care MDs and the residency requirements alone define this. However...most dentists don't do residencies either and no one questions their training or skills. Of course, these are part of the reason I am choosing opt...I have better numbers than most of my friends that have gone the MD route....is that it appears the likelihood of having a good lifestyle outside of work is better than it is to pursue the route of and be a primary care md. And one can still be of great service to their fellow man as a primary care eye doctor...and not to mention make a good living too...Opts income I think depends so much on location and type of practice as I know many primary care MDs that make more than Opts. Of course I think I should be content if 5 years or so after obtaining my OD I'm making around $100,000/year.

Now to hope the legislators and insurance companies treat current & future ODs well (cause it looks very likely I'll be joining the bunch)🙂 and we can talk; 10,20, even 30 years from now, as do many current ODs; postiviely about the route we choose.

 

[3eb4me]

1. Is a optometrist really that much different from a family doctor? Both are primary care, and both will only handle the basics until it becomes beyound there scope for practice. (on a side note, OD's are begining to manage and co-manage more Dx's than ever before).

Can we really compare apples to oranges? A FP sees a variety of items during his/her course of the day, whereas an OD will do mostly refractions, a few contact patients, and I&R. Your definition of primary care is very limited for an OD.

 

[Hines302]

I agree... the MD route and schooling is much more difficult than that of an OD.

I also agree that the scope of primary care for an optometrist is much more narrow that than for an MD. However, as the population ages, I think OD's will see and co-manage many more Dx's and begin to see more variety (follow up care with surgery.. etc). The waitlist to see an OMD is 3 months or more where I live... (and forgot about it if you don't have good insurane) Furthurmore OMD residencies are not expanding... thus patients with 'simple' cases that would usually see an OMD will more than likely be seeing an OD in the future. Thats just my 2-cents tho. No one can see the future.

However, gsincom is right, lets hope insurance companies and future legislation treat us like the trained health care professions that we are (or will be).