Do you support Optometrists doing surgery? - ODs allowed to do scalpel surgery in OK!

[PBEA]

Thanks for your post. I think you make some very good points. I think what you listed above are within your scope of practice, unless you're actually performing laser procedures.

Thank you, I've lurked your posts and value your opinion.

In regards to training adequate numbers of primary eye care providers, there are adequate numbers. Optometry schools graduate over 1200 students per year compared to ophthalmology residencies that graduate over 400 ophthalmologists per year. There are currently over 40,000 optometrists working in the U.S. verses only ~15,000 ophthalmologists. In fact, the optometry lobby boasts how there is at least one optometrist located in almost every part of the country.

I did not mean to imply that there should be more graduating OD's (or OMD's for that matter). I'm of course biased and would agree to limiting both types of practitioner.

The points I want to emphasize are:

1) Optometry schools do a great job training primary eye care providers: fitting glasses & contact lenses, diagnosing and treating minor and early ocular diseases, and recognizing serious problems to refer.

Agree

2) We don't need to increase our numbers of optometrists. Some complain they aren't busy enough, and that they can't make enough money.

Agree

3) We may need more ocular surgeons in the future with the baby boomer generation getting older.

Disagree, although I can't say for sure what the demand will be

4) This thread is about revoking surgical rights for optometrists, not restricting your current scope of practice.

Every OD journal I've seen speaks about the OK law as being merely a "protection against restricted scope of practice actions by OMD's". NONE discuss the future optometric surgeon that is described in this forum. In fact, as I'm sure you are aware, the OK law was in response to an inquiry by an OK OMD, on OK OD scope of practice. The language of the OK response was unacceptable to OK OD's and then OK OMD's. OK exasperation led to the current wording. As we all know language does not always impart the truth (especially legalese). I find it very hard to believe that OD's are seeking "surgical rights", and have yet to see any evidence to support this. I read all the journals, and surf all the wires, if I'm missing something please try and correct me. In regards to the VA system, I would say that it is not subject to the rules that the rest of American healthcare follows. If a body of VA OMD's and OD's agree that with proper protocols, OD's may perform certain procedures, then so be it. I do not think that these decisions are made casually or without regard to patient safety.

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[Andrew_Doan]

I find it very hard to believe that OD's are seeking "surgical rights", and have yet to see any evidence to support this.

The seeking of the attorney general's opinon was due to the fact that OK ODs snuck in a law allowing them to do laser surgery and PRK in 1998. Yes, PRK is surgery. OK is the ONLY state allowing ODs to perform laser surgery and PRK. Doesn't this seem strange to all the ODs on this forum? Sure sounds strange to me.

Also, I met with Cynthia Bradford, MD from OK. Many ODs have approached her and expressed their desire to: 1) replaced general ophthalmologists; 2) perform cataract surgery. It may not be clearly stated in journals, but there is a plan to introduce optometric surgery.

Clearly, to introduce surgery NOW is suicidal to your field. But one year it's systemic meds. The next it's PRK, then LASIK, then retina lasers, then 'minor' lid surgeries, then blephs, and then cataracts. Do you see where the field is heading?

It's a clever political stategy. Pick away at something piece by piece, and it's more difficult to disapprove.

 

[PBEA]

The seeking of the attorney general's opinon was due to the fact that OK ODs snuck in a law allowing them to do laser surgery and PRK in 1998. Yes, PRK is surgery. OK is the ONLY state allowing ODs to perform laser surgery and PRK. Doesn't this seem strange to all the ODs on this forum? Sure sounds strange to me.

My mistake (a glaring one). I agree that it is unusual for OD's to be performing PRK in OK. I personally did not perform any PRK procedures in school. Did you?

Also, I met with Cynthia Bradford, MD from OK. Many ODs have approached her and expressed their desire to: 1) replaced general ophthalmologists; 2) perform cataract surgery. It may not be clearly stated in journals, but there is a plan to introduce optometric surgery.

I think it is also unusual for OK OD's to approach such a politically active OMD, ie Dr. Bradford, and declare their intent to perform surgery or to replace general OMD's. Seems suspicious to me. What plan are you referring to specifically?

Clearly, to introduce surgery NOW is suicidal to your field. But one year it's systemic meds. The next it's PRK, then LASIK, then retina lasers, then 'minor' lid surgeries, then blephs, and then cataracts. Do you see where the field is heading?

It's a clever political stategy. Pick away at something piece by piece, and it's more difficult to disapprove.

I see the obvious logic in your conclusion, and I might argue about some systemic medications, but still don't believe OD's (with our current training) will be trying to perform surgery. I guess time will tell.

 

[Andrew_Doan]

I see the obvious logic in your conclusion, and I might argue about some systemic medications, but still don't believe OD's (with our current training) will be trying to perform surgery. I guess time will tell.

I agree, with your current training no. However, you will see an attempt to establish optometric surgical residencies. Perhaps in 10, 20 or 50 years?

But why do we need an alternative (likely less rigorous/standardized/quality) route to train ophthalmic surgeons when we have a current system that works well and produces enough high quality surgeons? I cannot anticipate demand to be high enough to accomodate 1200 new 'optometric surgeons' per year. That's 3 fold the number of ophthalmology residents trained each year. Regardless, why should there be optometric surgeons? If you want to do surgery, then go to medical school and residency.

 

[Andrew_Doan]

I agree that it is unusual for OD's to be performing PRK in OK. I personally did not perform any PRK procedures in school. Did you?

Yes and no.

I didn't do PRK during medical school.

However, it's a matter of semantics, but after completing ophthalmology residency, I will have done PRK/LASIK/LASEK/ as well as PKP/SK/ and other corneal procedures; this is in addition to assisting in several fold more cornea and refractive surgery cases.

The answer to your question is yes.

I realize some ophthalmology programs have not offered their residents first-hand experience with refractive surgery like the University of Iowa; however, these residents do take courses, attend refractive surgery conferences, and are trained surgically to understand and deal with corneal problems. As surgeons, we develop a skill set that can be applied to several facets of ophthalmic surgery. For instance, performing a trabeculectomy surgery involves several fundamental steps shared by many other types of surgery: peritomy and conjunctiva dissection, making a paracentesis wound, scleral dissection, suturing conjunctiva, closing scleral wound, and understanding the surgical anatomy of the anterior segment. This is why it is essential to have only ophthalmic surgeons who have be trained with these fundamental skills to learn how to do LASIK and other surgical procedurs, regardless of how trivial the surgery may appear to non-surgeons.

In addition to the above, the surgeon must also know when to cut and not to cut; thus, not only is surgical proficiency is required, the surgeon must also have a thorough knowledge of the indications, contraindications, risks, and benefits of doing a surgery. This is learned best by having surgeons complete medical school and then a standardized, rigorous, and comprehensive ophthalmology residency.

 

[PBEA]

I agree with everything in your previous two posts! I never meant to imply that current OMD training was not comprehensive for all ocular medicine. I would like to ask you another question though. If you consider everything you know about ocular medicine, do you think that an OD who completes OD school only, and then completes full ophthalmology residency/fellowship, is capable of performing surgery? I would argue that yes, they would be. I would further argue that they might be even better trained in ocular medicine then the current route! When you finish medical school your ocular skills amount to a fart in a hurricane (no offense). Your systemic foundation is excellent of course, but you really have a long way to go with eyeballs. After your residency, this of course is not the case. Contrast a medical school graduate with the optomety school graduate, for ocular medicine this is no contest, OD's win everytime. Now imagine for a moment, if the cream of the OD grads, were to go on to ophthalmology residencies and the rest stayed in primary care. I like to think this is the educational model that should have occurred in the first place. Rings of dentistry and OMFS, and as you have stated this is a sound process (some others may disagree), I agree with the dentistry model because it makes sense, it is pure logic. Adequate primary dentists are produced while adequate skilled tertiary OMFS are produced. No oversupply, limited by the educational slots available. I'm not trying to put medical school down, for heavens sake, primary MD's need to deal with a far wider breadth for differential, it's mind boggling from where I sit. Bring on the flames, please.

 

[Andrew_Doan]

If you consider everything you know about ocular medicine, do you think that an OD who completes OD school only, and then completes full ophthalmology residency/fellowship, is capable of performing surgery?

I disagree. I don't think optometry school prepares ODs to go into ophthalmology residency/fellowships. So much of what I do everyday deals with systemic disease. You don't receive that level of training in optometry school. I see a big difference in how ODs view patients vs MDs. There are things that MDs will do and order because of their general medicine background. Without the training in medical school and a general medicine internship, ODs and MDs are not equal.

Let's assume that we allow optometrists to apply to ophthalmology residency training programs. You will have to pass 3 steps of the United States Medical Licensing Examination. This can only be done with the completion of medical school.

Not only do you have to pass the Steps, you'll have to score better than the 80% which is currently the average score for matched residents.

In regards to OMFS/dentistry, this field has established itself as a surgical specialty for hundreds of years. The OMFS residents also complete one year of medicine/surgical internship.

You may think it's only surgery, but I spent 2 weeks with an inpatient post-operatively managing their diabetes and hypertension. Do you think optometry schools teach you enough to manage these problems in your pre- and post-operative patients?

 

[mdkurt]

If you consider everything you know about ocular medicine, do you think that an OD who completes OD school only, and then completes full ophthalmology residency/fellowship, is capable of performing surgery? I would argue that yes, they would be. I would further argue that they might be even better trained in ocular medicine then the current route! When you finish medical school your ocular skills amount to a fart in a hurricane (no offense). .

I agree with Andrew. Medical training is required for several reasons prior to performing surgery.

1. You need to understand medical management of the patient's comorbidities. Can the patient stop coumadin? What about their hypertensive meds preop? What about their oral hypoglycemics? Their insulin? Does an anesthesiologist need to be present? What kind of anesthesia is needed? Do they have the lung function necessary to lie flat?

2. You have to be able to perform surgery. In order to perform ophthalmic surgery, you have to be entirely comfortable with the operative setting prior to laying hands on your first patient. Little things, like learning how to scrub properly, matter. Learning how to do a sterile prep matters. Bigger things, like having four years of suturing behind you and knowing how to handle very sharp objects efficiently matter.

3. You have better training and a much more comprehensive understanding of the eye. Sorry, but in my training program we rubbed elbows with optometry students on a daily basis. I figured that the 4th year opto students would know more about the eyeball than I did when I started. I figured wrong. I'm not sure why, but even in the 2nd month of my ophtho residency I knew reams more than the 4th year opto students about how to approach and manage the patient. I don't know why this is. My guess is that my four years of med school amounted to more than a fart in a hurricane.

 

[Richard_Hom]

I agree with Andrew. Medical training is required for several reasons prior to performing surgery.

I agree with Dr. Doan and yourself but on a differnt perspective. I don't believe that optometry training is equivalent to ophthalmology training. I also don't believe that both professions are approaching the patient in the same fashion nor do I see it being parallel in the near future.

In a way, optometry and ophthalmology approach the patient in vastly different ways and thus, I believe that there is less overlap than others would believe or intend to be. Alternatively, because of this gap, one cannot conclude that there is overlap when none is present.

Regards,
Richard

 

[BelugaMD]

Let's get one thing straight. It doesn't take a genius to be a physician. Let's not inflate ourselves here. It may be difficult to land a position in residency in certain specialties. However, this does not mean that one need be "extremely bright" to actually practice as an ophthalmologist. Do we want idiots doing eye surgery? No. Without a doubt, a certain level of training is required. However, the idea that optometrists do not have the intelligence to learn the manual dexterity and procedural skills to perform eye surgery is ridiculous.

Besides, what is medical school but a bunch of BS for 2 yrs, a ton of shadowing and acting like you're actually involved in pt care for another yr, and then trying to impress ophthalmology residents and staff for another month (or 2-3 months if your not so "extremely bright" that you need to do an away elective to match). In the meantime, optometrists are actually learning about the eye for 4 yrs. So what's wrong with them obtaining extra training to learn additional pt care skills?

Yeah, yeah... they don't learn about "systemic diseases." I guess, teratology of fallot, histology of the transitional cell CA of the bladder, and prostate examination technique are very relevant to the eye. But somehow, I don't think they are missing out on very much.

I believe the sentiment against optometrists is more political and financial than ophthalmologists would like the general public to believe. Sure, they would get compensated similarly for certain procedures/services. However, the added competition would decrease the compensation for ophthalmologists in the long run.

The argument often fed to the public is that ophthalmologists learn about the "entire" human body first, then they "specialize" in just the eye. Any medical school graduate would be full of it if they said that they could competently manage any serious systemic medical complication just after graduation. It is also often said that ophthalmologists are trained for 8 years whereas optometrists are trained for only 4. Let's not kid ourselves. The training received during medical school is extremely over-rated in the eyes of the public. Most of the first 4 years of medical school is irrelevant to the eye. You and I both know it. I heard all of you whining about it during the pediatric clerkship and on medicine rounds. So stop BSing the public.

Dental graduates have a nice arrangement that has worked out without any problems. They finish dental school and then obtain extra training to become oral and maxillary facial surgeons. Why should this pathway be unavailable to optometrists who would like to perform ocular surgery? We could even call these graduates "oculosurgeons." That way, ophthalmologists can still keep their name.

At this point, what can be done about this bill? Is limiting the scope during the rulemaking process the only form of recourse now? This is seriously threatning to the field of ophthalmology.

I was thinking maybe ophthalmology will have to change its "name" so optometrists cant use the similarity between the two names to obfuscate the issues. What about "Oculosurgeon".. still has the "O" though.

Its amazing that the extremely bright medical school graduates that go into ophtho are now on par with optometrists - some (not all) of whom went that route b/c they couldnt get into medical school.

 

[Andrew_Doan]

Yeah, yeah... they don't learn about "systemic diseases." I guess, teratology of fallot, histology of the transitional cell CA of the bladder, and prostate examination technique are very relevant to the eye. But somehow, I don't think they are missing out on very much.

What stage are you in your training? Are you in ophthalmology? If you browse the cases presented on www.eyerounds.org, then how can you say that knowledge about systemic diseases is trivial in the management of ophthalmic diseases?

I hear similar unfounded arguments from physicians who are not ophthalmologists. However, they think twice when their diagnosis of "red eye" turns out to be orbital lymphoma:

http://webeye.ophth.uiowa.edu/eyeforum/case9.htm

or when their diagnosis of dehydration and headache actually turns out to be TTP-HUS:

http://webeye.ophth.uiowa.edu/eyeforum/case1.htm

or a diabetic retinopathy case that actually was exacerbated by advanced accelerated hypertension:

http://webeye.ophth.uiowa.edu/eyeforum/case17.htm

 

[mdkurt]

Let's get one thing straight. It doesn't take a genius to be a physician. Let's not inflate ourselves here. It may be difficult to land a position in residency in certain specialties. However, this does not mean that one need be "extremely bright" to actually practice as an ophthalmologist. Do we want idiots doing eye surgery? No. Without a doubt, a certain level of training is required. However, the idea that optometrists do not have the intelligence to learn the manual dexterity and procedural skills to perform eye surgery is ridiculous.

When I was on the interview trail, an attending asked me why I thought I could learn cataract surgery. What a ridiculous question. Cataract surgery is a learned skill, just like using utensils or walking upright. Certainly, optometrists could learn cataract surgery given enough time and training, but that would look a lot like med school. Intelligence has nothing to do with it. Optometric training isn't set up to produce surgeons.

 

[OzDDS]

So if OD's started doing surgery, would it work like CRNA's now doing general anest? Would Optho's have to supervise, take reduced pay, and still carry all the malpractice burden? Would they get paid the same or less for similar procedures. I'm not sure, but if a CRNA as opposed to a anest did your general, would you have to pay the same? any thoughts?

 

[daelroy]

I agree that it is bogus for optometrists to be performing surgery. But when do opthalmologists take responsibility for this? Yeah, you heard me. This threat from optometrists has been looming for the last 10 years and opthalmologists never took it seriously. It didn't just happen overnight. This is the risk you take when you intentionally limit the supply of opthalmologists that are produced each year to preserve high salaries. Dermatologists and ENT is the same way. If you don't start creating more residencies and opportunities for opthalmologists and other specialists to be trainied, you are going to have situations like this occur.

And growing up in a rural area, I can empathize with the lack of specialist care. They all practice in the city and we had to drive at least an hour to see anyone like an opthalmologist.

I'm not totaly unsympathetic to the optometrists. This is going to happen to other fields of medicine unless they make an effort to produce more specialists as opposed to intentionally limiting the supply for $$$. This is going to spread beyond Oklahoma. I can see states like South Dakota, Arizona, New Mexico, Wyoming and other states following suit.

 

[JennyW]

I agree that it is bogus for optometrists to be performing surgery. But when do opthalmologists take responsibility for this? Yeah, you heard me. This threat from optometrists has been looming for the last 10 years and opthalmologists never took it seriously. It didn't just happen overnight. This is the risk you take when you intentionally limit the supply of opthalmologists that are produced each year to preserve high salaries. Dermatologists and ENT is the same way. If you don't start creating more residencies and opportunities for opthalmologists and other specialists to be trainied, you are going to have situations like this occur.

And growing up in a rural area, I can empathize with the lack of specialist care. They all practice in the city and we had to drive at least an hour to see anyone like an opthalmologist.

I'm not totaly unsympathetic to the optometrists. This is going to happen to other fields of medicine unless they make an effort to produce more specialists as opposed to intentionally limiting the supply for $$$. This is going to spread beyond Oklahoma. I can see states like South Dakota, Arizona, New Mexico, Wyoming and other states following suit.

As a OD, I normally wouldn't come to the defense of too many OMDs, but I will in this case.

It's not as simple as just creating more residency spots. You can't just increase residency slots by 30% if you don't also have a 30% increase in demand for eye care so that residents can get the training that they need. If you're going to spread the same population over more residents, that will be less surgery and cases for each resident to see, and can result in lower quality education.

Plus, even if you did do this, there is no guarantee that the new residents would work in underserved areas anyway.

You grew up in a rural area. Do you intend to go back there to practice? It would probably serve these communities to offer more and/or better incentives to new graduates to take up practice in underserved areas.

Jenny

 

[Mirror Form]

I agree that it is bogus for optometrists to be performing surgery. But when do opthalmologists take responsibility for this? Yeah, you heard me. This threat from optometrists has been looming for the last 10 years and opthalmologists never took it seriously. It didn't just happen overnight. This is the risk you take when you intentionally limit the supply of opthalmologists that are produced each year to preserve high salaries. Dermatologists and ENT is the same way. If you don't start creating more residencies and opportunities for opthalmologists and other specialists to be trainied, you are going to have situations like this occur.

And growing up in a rural area, I can empathize with the lack of specialist care. They all practice in the city and we had to drive at least an hour to see anyone like an opthalmologist.

I'm not totaly unsympathetic to the optometrists. This is going to happen to other fields of medicine unless they make an effort to produce more specialists as opposed to intentionally limiting the supply for $$$. This is going to spread beyond Oklahoma. I can see states like South Dakota, Arizona, New Mexico, Wyoming and other states following suit.

This is incorrect! If ophtho was like derm and kept our numbers low to preserve high salaries, then you'd have a good point. However, currently most desirable places to live are saturated or over-saturated with ophthalmologists. Until the boomers hit, there will probably continue to be too many ophthalmogists. And the majority of ophtho surgery is elective anyway, so if someone from a rural town has to drive two hours to an ophthalmologist, isn't the end of the world.

 

[JennyW]

This is incorrect! If ophtho was like derm and kept our numbers low to preserve high salaries, then you'd have a good point. However, currently most desirable places to live are saturated or over-saturated with ophthalmologists. Until the boomers hit, there will probably continue to be too many ophthalmogists. And the majority of ophtho surgery is elective anyway, so if someone from a rural town has to drive two hours to an ophthalmologist, isn't the end of the world.

If you mean by "elective" that the patient is not likely to die, then I guess it's elective. BUt the problem isn't the surgery. It's all the followup visits that are normally needed AFTER the surgery. If you are supposed to be seen at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, would you really want to drive 2 hours each way?

Jenny

 

[Mirror Form]

If you mean by "elective" that the patient is not likely to die, then I guess it's elective. BUt the problem isn't the surgery. It's all the followup visits that are normally needed AFTER the surgery. If you are supposed to be seen at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, would you really want to drive 2 hours each way?

Jenny

Ofcourse I wouldn't "want" to drive two hours each way. But I'd gladly do that instead of having a non medical doctor do my surgery. And besides, even if optoms were allowed to operate, it wouldn't do much for the residents of rural areas unless we REALLY over-saturated the market with eye surgeons, I don't see why anyone thinks they'd all just move to the country.

Also, every specialty area of medicine is needed more in rural areas. That's just the way it's always going to be in rural areas. Many other types of specialists, like specialized lawyers, specialized craftsmen and pretty much any kind of specialized person is going to be hard to find in a rural area.

 

[Andrew_Doan]

If you mean by "elective" that the patient is not likely to die, then I guess it's elective. BUt the problem isn't the surgery. It's all the followup visits that are normally needed AFTER the surgery. If you are supposed to be seen at 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year, would you really want to drive 2 hours each way?

Jenny

After 1 month post-op cataract surgery, I feel comfortable with optometrists caring for patients. Optometrists can do the 6 week refractions and earn $$$ for the exam and glasses.

 

[daelroy]

As a OD, I normally wouldn't come to the defense of too many OMDs, but I will in this case.

It's not as simple as just creating more residency spots. You can't just increase residency slots by 30% if you don't also have a 30% increase in demand for eye care so that residents can get the training that they need. If you're going to spread the same population over more residents, that will be less surgery and cases for each resident to see, and can result in lower quality education.

The demand already exceeds the supply particularly in many parts of the country. You assume the supply of opthalmologists is currently meeting demands which is not true. Do you realize how difficult it is for many people to see an opthalmologist? There are people that drive and even fly to a city just to see one. There is a huge demand for specialists like opthos, derm and others in underservered areas.

Plus, even if you did do this, there is no guarantee that the new residents would work in underserved areas anyway.

There is no guarantee they would remain in the city either, but they are likely to move due to simple economics. If a city becomes saturated with opthalmologists, and one learns that he or she can move 60 miles away and earn twice as much in addition to working better hours, they will seriously contemplate moving. Someone will meet that demand. The problem is there are so few opthalmologists that they have no incentive to move to an underserved area. Why should they when they don't have to fear competition in most cities in the U.S.?

You grew up in a rural area. Do you intend to go back there to practice? It would probably serve these communities to offer more and/or better incentives to new graduates to take up practice in underserved areas.

That doesn't mean anything. I already know two people who grew up in large cities that are practicing in underserved areas. They wanted to get away from the city in addition to earning more money and having more control over their hours. Besides, I wasn't like 99% of the people in my town in that I traveled extensively and went to part of my high school, college and medical school of out of state. But the people that I communicate with on occasion are in fact contemplating practicing back home. Many people get burnt out by med school and residency and wouldn't living in an underserved area for a short time so they can earn more money and pay off their loans faster. It happens all the time.

 

[daelroy]

This is incorrect! If ophtho was like derm and kept our numbers low to preserve high salaries, then you'd have a good point. However, currently most desirable places to live are saturated or over-saturated with ophthalmologists. Until the boomers hit, there will probably continue to be too many ophthalmogists. And the majority of ophtho surgery is elective anyway, so if someone from a rural town has to drive two hours to an ophthalmologist, isn't the end of the world.

Well I guess I have a good point then. According to the match statistics for the past 5 years, there were 1260 optho spots compared to 994 derm spots. There were only 266 more optho spots than the total number of derm spots over a 5 year period. That averages to only 53 more opthalmologists than dermatologists produced each year. How is this so different than derm? Just to give you an idea of how few a number of spots this is, there were 3024 orthopedic surgery spots in the same 5 year period. The most desired places to live may be saturated with opthalmologists but these places are also saturated with dermatologists and every other physician as well. The other "non-desired" cities are in short supply of opthalmologists.

 

[Andrew_Doan]

There is no guarantee they would remain in the city either, but they are likely to move due to simple economics. If a city becomes saturated with opthalmologists, and one learns that he or she can move 60 miles away and earn twice as much in addition to working better hours, they will seriously contemplate moving. Someone will meet that demand. The problem is there are so few opthalmologists that they have no incentive to move to an underserved area. Why should they when they don't have to fear competition in most cities in the U.S.?

It's not as simple as you make it seem. Increasing the number of residents produced per year will not equate to more moving to rural areas. Many rural areas do not have enough patients to support a surgical ophthalmologist; thus, for a sub-specialist to make a living, he/she will have to travel between multiple offices separated by considerable distances to generate enough surgical volume. It's not the 'simple' life that you suggest above.

As stated by others above, a shortage of physicians in rural areas is a problem not unique to ophthalmology, but a problem with all the specialties. The cities are over-saturated with physicians right now, but few are moving to rural areas.

Consider this article:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9682706

Subspecialty distributions of ophthalmologists in the workforce.
Lee PP, Relles DA, Jackson CA.

Arch Ophthalmol. 1998 Jul;116(7):917-20.

OBJECTIVE: To describe the distribution of the supply and requirements for subspecialty ophthalmologists. METHODS: Estimates from the Eye Care Workforce Study were used to provide subspecialty-based assessments of the supply and public health need, as well as market demand, for care provided by subspecialists. Reconciliation with the boundary models (optometry first, ophthalmology first) of the Eye Care Workforce Study and current market status also were performed. RESULTS: Whether subspecialists are in excess depends first on which boundary model most closely approximates the current market conditions. Under an optometry-first model, 70% of all ophthalmologists are in excess, although subspecialists (39%) are relatively less in excess than comprehensive ophthalmologists (91% excess). Under an ophthalmology-first model, no ophthalmologists would be in excess. Extrapolating from current market conditions, a slight excess of ophthalmologists exists, probably proportional across subspecialists and comprehensive ophthalmologists. Future growth in the ophthalmologist supply will be almost entirely among subspecialists. CONCLUSION: Under current market conditions, substantial excesses in subspecialist ophthalmologists are likely to develop and grow worse over time, given current training levels.

and this one:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9098304

Estimating eye care workforce supply and requirements.
Ophthalmology. 1995 Dec;102(12):1964-71; discussion 1971-2.

Lee PP, Jackson CA, Relles DA.

PURPOSE: To estimate the workforce supply and requirements for eye care in the United States. METHODS: Three models were constructed for analysis: supply of providers, public health need for eye care, and demand (utilization) for eye care. Ophthalmologists, other physicians, and optometrists were included in the models. Public health need was determined by applying condition-specific prevalence and incidence rates from population-based and other epidemiologic studies. Demand was determined by use of national databases, such as the National Ambulatory Care Survey, National Hospital Discharge Survey, and Medicare Part B. Time requirements for care were obtained through a stratified sample survey of the membership of the American Academy of Ophthalmology. RESULTS: Under modeling assumptions that use a work-time ratio of one between optometrists and ophthalmologists and between specialist and generalist ophthalmologists, a significant excess of eye care providers exists relative to both public health need and demand. Changes in the work-time ratio, work-hours per year per provider, care patterns for the same condition, or other factors could significantly reduce or eliminate the surplus relative to need. CONCLUSION: If optometrists are the preferred primary eye care provider, ophthalmologists would be in excess under all demand scenarios and all need scenarios where the optometrist to ophthalmologist work-time ratio is greater than 0.6. No excess of ophthalmologists would exist if ophthalmologists are the preferred primary eye care provider. Data on the appropriate work time ratio will help refine estimates of the imbalance between supply and requirements.

 

[OzDDS]

http://www.skoopy.com/show2.php?id=663&type=PIC

I hear these things are big buisness for Optometrists these days.. ha

 

[Mirror Form]

Well I guess I have a good point then. According to the match statistics for the past 5 years, there were 1260 optho spots compared to 994 derm spots. There were only 266 more optho spots than the total number of derm spots over a 5 year period. That averages to only 53 more opthalmologists than dermatologists produced each year. How is this so different than derm? Just to give you an idea of how few a number of spots this is, there were 3024 orthopedic surgery spots in the same 5 year period. The most desired places to live may be saturated with opthalmologists but these places are also saturated with dermatologists and every other physician as well. The other "non-desired" cities are in short supply of opthalmologists.

Uhm, this might come as a surprise to you, but there are different demands for different specialities. Just b/c there are 3024 ortho spots each year doesn't mean that every other specialty needs 3024 spots too. Actually, that's an incredibly *****ic thing to say. If these are the best numbers you have to argue your cause, then I rest my case.

Oh and by the way, according to your numbers there are well over a thousand more ophthalmologists being produced per four year period then dermatologists. That is a very significant number in small specialized fields like ophtho and derm.

 

[Mirror Form]

The demand already exceeds the supply particularly in many parts of the country. You assume the supply of opthalmologists is currently meeting demands which is not true. Do you realize how difficult it is for many people to see an opthalmologist? There are people that drive and even fly to a city just to see one. There is a huge demand for specialists like opthos, derm and others in underservered areas.

Just b/c some person had to travel a long way to see an ophthalmologist . .. that proves absolutely NOTHING. As I said before, in many rural areas there is a LACK, not necessarily a "demand" of most types of specialists (not just medically related), in rural areas. Every small town can't support their own specialized surgeon in every different type of speciality. Hence they have to travel. There isn't enough work in a small town for every type of specialist to set up shop there.

Yes, there are other undesirable places to live that probably could support most specialists but still have shortages of them (not just ophthalmologists). But the only way to solve that problem would be to literally FLOOD the market with far more surgeons then we need, which would waste money and lower the standard of care.

 

[manwhoisthursdy]

There already is an alternative name which could be used - and is used in the UK - ophthalmic surgeon. Unfortunately, this name would marginalise those specialising in medical ophthalmology.

So call it "Medical opthalmology and opthalmic surgery." Specialists would still be "opthalmologists" (it's always easier when you don't have to change the common usage term) but it's relatively easy to change the name of a residency.

 

[jkin]

Is there a good website to follow the progress of this issue? Does anyone have an idea of the timeline for some sort of resolution?

 

[Andrew_Doan]

Is there a good website to follow the progress of this issue? Does anyone have an idea of the timeline for some sort of resolution?

http://capwiz.com/aao/home/

 

[Andrew_Doan]

On October 4, the Oklahoma Board of Examiners in Optometry unanimously adopted a regulation that would allow optometrists to perform some non-laser surgical procedures. The emergency rule defines proper scope of practice for non-laser surgical procedures and does include a list of 14 procedures excluded from the Scope of Practice of Optometry.

This action is a direct result of the passage of Oklahoma HB. 2321 in which language was inserted at the last minute that further defined the practice of Optometry in Oklahoma to include "non laser surgery procedures as authorized by the Oklahoma Board of Examiners in Optometry pursuant to rules promulgated under the Administrative Procedures Act." The Oklahoma Governor now has 45 days to either reject or accept the regulation.

Ophthalmology testified during the hearing in opposition to the proposal and held a press conference, led by the AMA, the next morning condemning the regulation and calling on the governor to reject it.

A statewide radio news story and an ad are being run to counter the regulation. The ad calls on the citizens of Oklahoma to contact the governor. We encourage all ASCRS members to contribute to the Surgical Scope Fund, so we can continue to fight the battle in Oklahoma.

 

[JennyW]

On October 4, the Oklahoma Board of Examiners in Optometry unanimously adopted a regulation that would allow optometrists to perform some non-laser surgical procedures. The emergency rule defines proper scope of practice for non-laser surgical procedures and does include a list of 14 procedures excluded from the Scope of Practice of Optometry.

This action is a direct result of the passage of Oklahoma HB. 2321 in which language was inserted at the last minute that further defined the practice of Optometry in Oklahoma to include "non laser surgery procedures as authorized by the Oklahoma Board of Examiners in Optometry pursuant to rules promulgated under the Administrative Procedures Act." .

I have been unable to find a link. What exactly are these "14 procedures?"

Jenny

 

[John_Doe]

Excert from a 1994 PAC solicitation letter from the OK ODs in Action:

"We can eliminate ophthalmology from this state and prove to the nation that optometry can provide total medical and surgical treatment for the eye . . . We honestly believe that optometry can provide most (if not all) surgical eye care by 2000 . . . Ophthalmology is so weak politically that we see smooth sailing to the control of eye care in this state . . . In order to place our people in key decision making posiitions, we need your support now. Fortunately, ophthalmology is well behind us. As usual they're too busy making the big bucks to think past the first base. Our sources tell us they've done nothing at the state level regarding legislation. We'll trounce them." AND THEY DID

FACT:
Ten years later wee see the passage of OK law HB2321, which authorizes the board of mainly optometrists to decide what types of surgeries optometrists can perforn on the eye and face. The fact that optometrists can now perform surgery in Oklahoma should come as no surprise (and for that matter laser in the VAHs) - the ophthalmologists there were certainly forwarned - and probably gave squat to their PACs - there are 49 states to go and momentum not in our favor.

 

[JennyW]

Excert from a 1994 PAC solicitation letter from the OK ODs in Action:

"We can eliminate ophthalmology from this state and prove to the nation that optometry can provide total medical and surgical treatment for the eye . . . We honestly believe that optometry can provide most (if not all) surgical eye care by 2000 . . . Ophthalmology is so weak politically that we see smooth sailing to the control of eye care in this state . . . In order to place our people in key decision making posiitions, we need your support now. Fortunately, ophthalmology is well behind us. As usual they're too busy making the big bucks to think past the first base. Our sources tell us they've done nothing at the state level regarding legislation. We'll trounce them." AND THEY DID

FACT:
Ten years later wee see the passage of OK law HB2321, which authorizes the board of mainly optometrists to decide what types of surgeries optometrists can perforn on the eye and face. The fact that optometrists can now perform surgery in Oklahoma should come as no surprise (and for that matter laser in the VAHs) - the ophthalmologists there were certainly forwarned - and probably gave squat to their PACs - there are 49 states to go and momentum not in our favor.

That is all fine and well but I still wouldn't mind if someone could provide a link or a listing of what exactly these 14 procedures are that the OK board has said are within ODs scope of pracitce.

Jenny

 

[Andrew_Doan]

That is all fine and well but I still wouldn't mind if someone could provide a link or a listing of what exactly these 14 procedures are that the OK board has said are within ODs scope of pracitce.

Jenny

I'd love to see the list too. I think the concerning part is that the 14 procedures are currently excluded from the scope of practice in OK, which is a state that already has very broad privileges.

 

[JennyW]

I'd love to see the list too. I think the concerning part is that the 14 procedures are currently excluded from the scope of practice in OK, which is a state that already has very broad privileges.

That's a legitimate point. But if that's the case, then I'm not sure why the president of the state board is insisting that it does not expand scope of practice. I guess the only way to clear this up is to find out what they are.

Does anyone out there have any clue what these 14 procedures are??

Jenny

 

[Andrew_Doan]

October 11, 2004


WASHINGTON??Disastrous? is what the American Academy of Ophthalmology called the decision this week by the Oklahoma Board of Examiners in Optometry to allow optometrists to perform eye surgery with scalpels.

?It will be a sad day for Oklahoma citizens if this brazen move by the Oklahoma optometry board is permitted to stand,? said H. Dunbar Hoskins Jr., MD, Academy executive vice president. ?Allowing non-medical doctors to perform eye surgery is an enormous patient safety risk. Ophthalmologists have extensive medical or osteopathy school education, with internships in ophthalmology and surgical residencies before they perform delicate procedures on the eyes. Optometrists only have four years of optometric education.?

The Academy joined the Oklahoma Academy of Ophthalmology and the Oklahoma State Medical Association (OSMA) this week in presenting testimony in front of the Oklahoma optometry board on this regulation. As expected, the optometry board rejected the united House of Medicine?s concerns about patient safety and formally adopted rules greatly expanding optometry?s scope of practice. These include many ocular surgeries now only being performed by ophthalmologists.

All medical representatives testified that the regulation placed Oklahoma patients at risk and was not acceptable to the medical community. Those testifying included David Parke, MD, a member of the Academy Board of Trustees; Ann Warn, MD, president of the Oklahoma Academy of Ophthalmology; Cynthia Bradford, MD, Academy secretary for state affairs; and Amalia Miranda, MD.

?We are urging Governor Brad Henry to keep his promise to the citizens of Oklahoma to reject this dangerous surgery regulation,? said Dr. Bradford, a practicing ophthalmologist in Oklahoma City. ?The governor said the scope of practice of optometry would not be contracted or expanded. This regulation, coupled with passage of H.B. 2321 during the waning days of the Oklahoma state legislative session, allows individuals who are neither medical nor osteopathic doctors to use a scalpel on your eyes. That is scary. Surgery should only be performed by surgeons.?

The Academy and its allies held a press conference following the testimony urging Gov. Henry to reject the OD regulation in the name of patient safety. William Hazel, MD, AMA Board of Trustees member, spoke at the press conference, along with Steven Hinshaw, DO, president of the Oklahoma Osteopath Association; David Russell, MD, vice president of the OSMA; Dr. Warn and Dr. Bradford.

A concerned medical community cried ?foul? when OD surgical language was inserted into a conference committee substitute bill (H.B. 2321), which was fast-tracked through the legislature. In response, Gov. Henry issued a letter on April 20, 2004 to several healthcare provider groups. The governor clearly stated that the scope of practice for optometry would not be expanded or contracted under the new law. He also asserted his office would ?work with all parties during the rulemaking process to insure that this goal is accomplished.? However, when preliminary meetings were finished, the optometry board adopted a rule that allows non-surgeons to perform more than 100 types of surgeries. For example, optometrists will be able to: use a scalpel to cut the eyelid to remove skin cancer lesions, to cut the eye surface to remove cancer lesions, to stick a needle into the center of the eyeball to inject medication and to inject ?Botox? around the eye.

The governor has 45 days to either approve or disapprove these emergency rules, which carry the force and effect of law. Oklahoma is the only state that allows optometrists to perform certain eye surgeries. In all other states, only medical or osteopathic doctors are authorized to perform eye surgery.

The Academy will continue to work with its allies to fight expanded optometric scope of practice efforts it believes are detrimental to patient safety.

###

The American Academy of Ophthalmology is the voice for ophthalmologists and their patients in Washington, D.C., and is the world's largest organization of eye physicians and surgeons, with more than 27,000 members.

Reporter Contact: Sandra Remey, Governmental Affairs, 202.737.6662 or [email protected]

I want to see the complete list of procedures being considered. If they are approved to cut the eye surface, then optometrists may perform pterygium excisions, lamellar keratoplasty, superficial keratectomy, strabismus surgery, and scleral buckles?! All these procedures involve 'cutting the surface of the eye' without actually 'penetrating' the eye.

Also, why would an optometrist need to do an intravitreal injection, i.e., "stick a needle into the center of the eyeball to inject medication"?!

 

[Tony.]

I want to see the complete list of procedures being considered. If they are approved to cut the eye surface, then optometrists may perform pterygium excisions, lamellar keratoplasty, superficial keratectomy, strabismus surgery, and scleral buckles?! All these procedures involve 'cutting the surface of the eye' without actually 'penetrating' the eye.

Also, why would an optometrist need to do an intravitreal injection, i.e., "stick a needle into the center of the eyeball to inject medication"?!

Dr. Doan,

Im just a first year optometry student and, looking at my curriculum for the next four years, I dont think we'll be learning to cut eyes anytime soon (if at all). If this bill passes, wouldnt all optometry schools have to change their curriculum as well?

 

[JennyW]

I want to see the complete list of procedures being considered. If they are approved to cut the eye surface, then optometrists may perform pterygium excisions, lamellar keratoplasty, superficial keratectomy, strabismus surgery, and scleral buckles?! All these procedures involve 'cutting the surface of the eye' without actually 'penetrating' the eye.

Also, why would an optometrist need to do an intravitreal injection, i.e., "stick a needle into the center of the eyeball to inject medication"?!

Does the new law REALLY allow those procedures to be performed, or is this just a "scare tactic" for the opthalmology academy? Why does both the optometry board (admittedly biased) and the governor (don't see why HE would be biased) both insist that this law does NOT expand scope of practice?

Where is this mysterious list of "new procedures?" From the tone of that article, it has gone from 14 to "hundreds." What's that all about?

There is a contact for the governmental affairs person at the ophthalmological society. Have you emailed this person Dr. Doan? What do they have to say?

Jenny

 

[mike3kgt]

Let's get one thing straight. It doesn't take a genius to be a physician. Let's not inflate ourselves here. It may be difficult to land a position in residency in certain specialties. However, this does not mean that one need be "extremely bright" to actually practice as an ophthalmologist. Do we want idiots doing eye surgery? No. Without a doubt, a certain level of training is required. However, the idea that optometrists do not have the intelligence to learn the manual dexterity and procedural skills to perform eye surgery is ridiculous.

Besides, what is medical school but a bunch of BS for 2 yrs, a ton of shadowing and acting like you're actually involved in pt care for another yr, and then trying to impress ophthalmology residents and staff for another month (or 2-3 months if your not so "extremely bright" that you need to do an away elective to match). In the meantime, optometrists are actually learning about the eye for 4 yrs. So what's wrong with them obtaining extra training to learn additional pt care skills?

Yeah, yeah... they don't learn about "systemic diseases." I guess, teratology of fallot, histology of the transitional cell CA of the bladder, and prostate examination technique are very relevant to the eye. But somehow, I don't think they are missing out on very much.

I believe the sentiment against optometrists is more political and financial than ophthalmologists would like the general public to believe. Sure, they would get compensated similarly for certain procedures/services. However, the added competition would decrease the compensation for ophthalmologists in the long run.

The argument often fed to the public is that ophthalmologists learn about the "entire" human body first, then they "specialize" in just the eye. Any medical school graduate would be full of it if they said that they could competently manage any serious systemic medical complication just after graduation. It is also often said that ophthalmologists are trained for 8 years whereas optometrists are trained for only 4. Let's not kid ourselves. The training received during medical school is extremely over-rated in the eyes of the public. Most of the first 4 years of medical school is irrelevant to the eye. You and I both know it. I heard all of you whining about it during the pediatric clerkship and on medicine rounds. So stop BSing the public.

Dental graduates have a nice arrangement that has worked out without any problems. They finish dental school and then obtain extra training to become oral and maxillary facial surgeons. Why should this pathway be unavailable to optometrists who would like to perform ocular surgery? We could even call these graduates "oculosurgeons." That way, ophthalmologists can still keep their name.

Let's please clarify in regards to the role of dentistry in regard to oral health and compare and contrast a similar situation occurring in dentistry.

First, dental students complete 4 years of basic training (like medical school) where we obtain a comprehensive educational experience of the entire oral condition. Our scope of training covers oral surgery, periodontal surgery, and other various complicated surgical procedures. Dentistry, historically, is a surgical profession and the scope of general dentistry (i.e. a 4 year graduate) may perform advanced surgical procedures without advanced training (although most do!). Oral & maxillofacial surgery is a sub-specialty of dentistry for students who are so interested in limiting their scope of practice to the surrounding structures of teeth as opposed to treating dental decay.

A comparison of OD/OMD to Dental/OD is inappropriate. Optometry is not a surgical profession, however, to my understanding; it is a preventative/primary care profession.

Second, let's look at what is occurring in dentistry right now. Recently (this summer), a push began among the dental hygiene association to open scope of practice to provide direct restorative treatment to the public (a hygiene practitioner program). What is the publicized reason for the push? - due to oral health discrepancies and better provide rural care access. Does this sound familiar??

A dentist/hygienist comparison to OD/OMD is more appropriate when considering the true scope of all professions. Hygienists are not trained in surgical care, administration of local anesthetics, and direct care to the public, however, the association is fighting for those privileges. Both hygienists and optometrists provide an invaluable service to our community, however, I'd be reluctant to expand the scope of either professions to include surgical treatment (yes, dentistry is surgical treatment )

To all: the same thing occurred with nurse practitioners and physician assistants. They fought in the past to expand their scope of practice beyond a physician's office in several states due to "rural health discrepancies". Please do not ignore the past and encourage discussion amongst all of your colleagues about the seriousness of these initiatives upon our professions.

 

[ZR1]

i wanna know who the med students/MD/DOs are who said ABSOLUTELY yes to optometrists performing surgery and why on earth u are saying absolutely yes?!

 

[odieoh]

i wanna know who the med students/MD/DOs are who said ABSOLUTELY yes to optometrists performing surgery and why on earth u are saying absolutely yes?!

I would suspect that these are OD's, OD students, or just OD sympathizers posing into said demographic. That or a med student/MD/DO whose close relative happens to be an OD.

 

[ring mod]

A dentist/hygienist comparison to OD/OMD is more appropriate when considering the true scope of all professions.

This is a point well taken. Also, I'm impressed that someone from the dental field has taken the time to view this forum - I wish I could say that I've returned the favor...

2 Thoughts:

1. I think it extremely important that we make it clear (in light of Beluga's commentary) that we are not attacking either the INTELLIGENCE or the COMPETENCE of currently practicing optometrists or optom students. They are intelligent and competent people who could certainly obtain MD/DO degrees and operate very effectively on patients - the argument lies solely in a question of training requirements for the performance of various procedures.

2. What would happen if we were to divorce ourselves from the nature of the training that currently exists (ophthalmology or optometry) and ask the question "what training should be required of an ophthalmic surgeon?" Meaning this: if you were to design training for such a surgeon from the ground up, would you choose to do so through medical schools or optometry schools? What if you could design a completely free-standing program exclusively for ophthalmic surgery? I say this because I voted emphatically against optometrists performing surgery in the above poll, but I also recognize that there are elements of my MD training that really have no application in ophthalmic surgery (e.g. a 6-week rotation in psychiatry). There undoubtedly needs to be general medical training for anyone performing ANY surgery, but what should be the nature of such training, and how much does someone really need? The preexistence of medical schools and osteopathic schools has alleviated us from the need to answer this question thus far, because we could simply say that the current medical curricula include MORE than enough general medical training for an ophthalmic surgeon, but now that another group (that clearly does NOT have enough general medical training for this purpose) would like to perform ophthalmic surgery, we are sort of forced to answer the question of exactly how much is necessary. The same question needs to be answered with respect to surgical training.

For the moment, it is clear that current optometry training is not sufficient to allow surgical intervention, even with additional surgical training, because the general medical knowledge issue has still not been dealt with. As an aside, both sides clearly have a political and financial interest in this, so suggesting that one side or the other is motivated by this amounts to stating the obvious and skirting the real issues which will affect patients.

rm

 

[Mirror Form]

Dr. Doan,

Im just a first year optometry student and, looking at my curriculum for the next four years, I dont think we'll be learning to cut eyes anytime soon (if at all). If this bill passes, wouldnt all optometry schools have to change their curriculum as well?

So, your plan is to first pass legislation allowing optometrists to do surgery, and then worry about training optometrists appropriately after they've already been doing surgery for years? I think the training would have to be changed first.

 

[Mirror Form]

Does the new law REALLY allow those procedures to be performed, or is this just a "scare tactic" for the opthalmology academy? Why does both the optometry board (admittedly biased) and the governor (don't see why HE would be biased) both insist that this law does NOT expand scope of practice?

Where is this mysterious list of "new procedures?" From the tone of that article, it has gone from 14 to "hundreds." What's that all about?

There is a contact for the governmental affairs person at the ophthalmological society. Have you emailed this person Dr. Doan? What do they have to say?

Jenny

You're in some serious denial about what your field is doing right now!

 

[JennyW]

You're in some serious denial about what your field is doing right now!

Oh sledgie,

I'm pretty confident that I know a lot more about what's going on in my field than a medical intern who's running around applying to "programs that suck" because "applicants with better resume's then yours end up not matching anywhere."

But just for a laugh, why don't you go ahead and fill me and everyone else in on "what my field is doing right now."

That should be interesting.

Jenny

 

[Andrew_Doan]

Does the new law REALLY allow those procedures to be performed, or is this just a "scare tactic" for the opthalmology academy? Why does both the optometry board (admittedly biased) and the governor (don't see why HE would be biased) both insist that this law does NOT expand scope of practice?

I need to see a list of approved procedures too. I'll try to request one from the AAO.

The Governor may be biased because of $$$.

I think his son or one of his close family members is an optometrist. Can someone verify this?

 

[Mirror Form]

Oh sledgie,

I'm pretty confident that I know a lot more about what's going on in my field than a medical intern who's running around applying to "programs that suck" because "applicants with better resume's then yours end up not matching anywhere."

But just for a laugh, why don't you go ahead and fill me and everyone else in on "what my field is doing right now."

That should be interesting.

Jenny

I wouldn't expect you to understand anything about matching in ophthalmology. Ophthalmology programs are actually extremely competitive, unlike optometry schools that have the same number of applicants as slots. Once you go through a similarly competitive matching process as I am, then you can talk some trash. But as of now, you're just making yourself look foolish.

As for what your field is doing, it's pretty obvious that oklahoma optometrists are trying to become surgeons. If you can't see that from all the quotes and data presented in this thread, then you're in some serious denial.

It's pathetic that the best explanation you can think of is that it this might just all be "scare tactics." Rrriiiiiiiiggggggggghhhhhhtttt, you just keep telling yourself that

 

[Andrew_Doan]

I wouldn't expect you to understand anything about matching in ophthalmology. Ophthalmology programs are actually extremely competitive, unlike optometry schools that have the same number of applicants as slots. Once you go through a similarly competitive matching process as I am, then you can talk some trash. But as of now, you're just making yourself look foolish.

I don't think optometrists realize how difficult it is to match for ophthalmology. We just selected applicants for interview at Iowa, and it was a humbling experience.

First, these applicants had to get into medical school where there is only a 1:3 acceptance rate.

Second, Iowa received over 300 applications where 95% were in the top 1/2 of their medical school class and had USMLE scores above the 50th percentile. Amongst these applications, ~100 applicants had USMLE scores above the 250 mark (above the 95th percentile). However, we looked at other factors too, so having a high USMLE was not enough.

We could only select 60 for interview. Although not all 60 invited were AOA (top 5th-10th percentile of their medical school class) and 250+ USMLE, these applicants were awesome on paper. The majority had publications, completed humanitarian work abroad or at home, completed additional degrees, and/or completed multiple ophthalmology electives where they learned how to perform an ophthalmic exam with the slit lamp and indirect ophthalmoscopy.

There are only ~450 spots available. There are ~1000 applicants. From the 300 I saw who applied to Iowa, each will be competitive for residency spots at other programs.

Although some applicants are looking for "programs that suck", these applicants are not at the bottom of their class in medical school. In fact, these applicants are strong too. The average number of programs people apply to is 41 programs! This statistic alone speaks for the competitive nature of the ophthalmology match.

 

[Andrew_Doan]

"what training should be required of an ophthalmic surgeon?" Meaning this: if you were to design training for such a surgeon from the ground up, would you choose to do so through medical schools or optometry schools? What if you could design a completely free-standing program exclusively for ophthalmic surgery? I say this because I voted emphatically against optometrists performing surgery in the above poll, but I also recognize that there are elements of my MD training that really have no application in ophthalmic surgery (e.g. a 6-week rotation in psychiatry).

These are good comments. However, I think every rotation in medical school is important to provide complete medical and surgical care for patients. Knowing when to perform surgery is just as important as knowing how to do the surgery.

For instance, knowledge of psychiatry plays an important role in providing complete medical and surgical care to patients. In ophthalmology, we have patients who have major depression, suicidal thoughts, schizophrenia, bipolar disorder, and other psychiatric illnesses. As physicians, it's important to recognize these illnesses and to refer to psychiatry. Second, it would be dangerous to provide surgical care to patients who will not take their post-operative drops due to a major psychiatric illness, such as schizophrenia. Will I be prescribing anti-psychotics? No. Am I glad that I am familiar with the major psychiatric illnesses? Yes.

I cannot think of one rotation that has not been useful during my ophthalmology training.

Medicine - reasons are obvious.

Surgery - reasons are obvious.

Pediatrics - As ophthalmologists, we see many children. We must be able to examine and be aware of the illnesses associated with infants and children to provide competent medical and surgical care.

OB-GYN- Expecting mothers are our patients too. As ophthalmologists, we often monitor and screen for pre-eclampsia. We are also careful about the medical and surgical treatments that may affect the fetus.

Psych - As discussed above.

Emergency Medicine - Take call, and you'll understand why EM is important in managing ocular trauma. http://webeye.ophth.uiowa.edu/eyeforum/trauma.htm

Family Medicine - Because the majority of our patients are outpatients, it is important to have an understanding of how to manage hypertension, diabetes, cardiac abnormalities, and other major illnesses.

Neurology - This is obvious considering the numerous strokes and other nerve paralysis ophthalmologists diagnose and monitor.

Radiology is also very useful. We also apply this knowledge in several fields of medicine. I want my surgeon who is taking out a cavernous hemangioma or repairing an orbital fracture to know how to read a CT and MRI scan.

If surgery is to be performed safely, then there has to be an understanding of disease entities associated with the above fields of medicine. When we consent patients for sedation and surgery, it is important that the surgeon understands the patient's co-morbidities and how to manage them.

 

[JennyW]

I wouldn't expect you to understand anything about matching in ophthalmology. Ophthalmology programs are actually extremely competitive, unlike optometry schools that have the same number of applicants as slots. Once you go through a similarly competitive matching process as I am, then you can talk some trash. But as of now, you're just making yourself look foolish.

As for what your field is doing, it's pretty obvious that oklahoma optometrists are trying to become surgeons. If you can't see that from all the quotes and data presented in this thread, then you're in some serious denial.

It's pathetic that the best explanation you can think of is that it this might just all be "scare tactics." Rrriiiiiiiiggggggggghhhhhhtttt, you just keep telling yourself that

Bzzzzzzzzzztttttt. Nice try, Sledge.

http://www.opted.org/info_profile2.cfm

That hardly shows the same number of applicants as slots. But go ahead and think that if it makes you feel better about yourself.

And you don't have to generalize what a few renegade ODs in Oklahoma are trying to do to the entire profession. As someone who's been in practice for more than 10 years, I think I know a bit more about what's going on in my field than a medical intern.

As far as scare tactics go, according to the OMD academy, the number of "surgeries" that ODs are allowed to do originally was 14 with this new law. Now it's into the 100s. Sounds like scare tactics to me.

Do YOU have a list of these mysterious 14 procedures?

No one is going to deny that ophthalmology is a competetive match. But don't worry Sledge. If you don't match at any of your "programs that suck" I guess you could always go to optometry school. According to you, we'll all be surgeons within a year anyways.

Jenny

 

[Andrew_Doan]

The ratio of optometry applicants to number of positions is 1.7 : 1

http://www.opted.org/info_profile.cfm

"For academic year 2003-2004, 2,226 individuals applied for admission to the seventeen schools and colleges of optometry in the United States (including Puerto Rico).

In 2003, a total of 1,305 optometry students received regular O.D. degrees from the seventeen schools and colleges of optometry in the United States (including Puerto Rico)."