- Joined
- Jul 10, 2006
- Messages
- 627
- Reaction score
- 3
Is making me sick...
Folks,
Optometrists in the state of Oklahoma or any other state in the country should not be doing SURGERY scapel PERIOD. CASE CLOSED. Take MCAT's, apply get in, do well, rock boards, research, connections, etc.....internship, 3 year ophth residency plus fellowship and do all surgery in the world you want.
I am ashame for the few colleagues in my profession who just don't get it!
My issue is with scope of practice. CRNA are trying to get licensed for fluoroscopy to place central lines? Anybody who has placed a line know fluoroscopy is overkill and at most ultrasound would be sufficient. It is clear that once licensed for "line placement" injctions for pain mgt are next. So this idea that they could not get credentialed is not the goal - just get approved and create the clinical opportunity down the road.
Surgery is the realm of surgeons and must require medical school. This constant attack to increase scope is making me dizzy.....
Ophthalmology should not be fighting this legislative battle on our own. We should be joining our fellow MD/DO colleagues and dealing with scope expansion together. Anesthesia, FP, IM, Psych, Ortho, Ophtho, Derm, OB/Gyn, etc should all get on the bandwagon soon, because when they start looking to cut healthcare costs...those cheaper midlevels will look very attractive to the lawmakers. And no, it's not a money concern of mine, but a quality of care issue.
I'm hesitant to really discuss this topic with med students and residents because it's a pretty rare resident who has an adequate frame of reference to really understand these issues, but for what it's worth...we'll try.
You guys are making a mistake if you think that this issue is about scope expansion or surgery. It's really not.
It's also not a quality of care issue on either side. It's about money. Let's be honest with ourselves about that. But contrary to what you may be thinking, it's not about money from surgical procedures because for the 10000th time, optometrists have enough of an understanding about business to know that if you triple the supply of providers overnight while the demand for whatever procedure you are talking about stays exactly the same, the reimbursement is going to go waaaaaaaaaay down. We will talk about the days of the $299 per eye LASIK ads on the side of of the highway as "the golden years."
The issues that optometrists REALLY want are:
1) Access to medical plan reimbursements
2) The ability to REASONABLY grow and evolve as techology and theraputic modalities evolve. We don't want to have to grovel before the medical board everytime some new eye drop comes on the market.
3) Our patients back when we refer them to ophthalmologists. Far too often, our patients simply get sucked into the opthalmology vortex. Now...I know, I know....you are all going to say that many times the patients request to stay with the ophthalmologist and we all know that sometimes that is true and that is just fine because most optometrists don't want the advanced diabetic patient with endstage glaucoma and Eale's Disease.
But this is the part where we need a little bit of honesty from the ophthalmolgists.....we all know that far too often, there is absolutely NO effort made to get the patient back to the referring doctor for ongoing care and far too often it is actually discouraged though there is no reason for it to be.
Now....if the only way that we can get our patients back from an ophthalmologist after a chalazion removal is to fight for the right to "perform surgery" and just do the chalazion removals ourselves, well then that's probably going to have to happen.
But the reality of it is is that there is no reason to dance these silly dances and just make a bunch of lawyers and lobbyists rich. I am not a spokesperson for the profession of optometry in any way but I honestly feel that many of these issues can be worked out relatively easily with some give and take on both sides. Optometrists would be willing to exclude invasive ocular surgeries if ophthalmologists would acknowledge that an OD is more than capable of removing a small piece of metal from a cornea and that that hardly rises to the level of "surgery." Optometrists would be willing to give up silly titles like optometric physician if ophthalmologists would lend a bit of a hand with medical insurance credentiallling.
These PESKY optometrists just won't go away. Sound like a bunch of 5 year olds "give me give me give me!"
And they cut and paste the same LAME A$$ reply no matter what the question asked. Strong work my friend...
It's actually not that rare that a "lowly" med student/resident understands what's going on. It's not rocket science. Really. We all know it's about MONEY. So spare us with your patronizing BS oh wise one...
The reason that I post the same "lame *** reply" is because that is the truth, and that's what the real issue is, yet no one addresses it. Also, there was no question asked. It's just the same old recycled blather about "ODs blinding people blah blah blah go to medical school blah blah blah took the MCATs blah blah blah PAC money blah blah blah."
And yea, it is quite rare that a medical student or a resident really knows what's going on because the vast majority of them have lived only in their academic and "teaching hospital" cocoons, taking in and regurgitating whatever vitriol is spewed towards optometry by their attendings all while accepting it as the gospel truth. Once you get yourself out of your little bubble and get a taste of what actual practice is like out in the real world, you'll have a much better grasp of where we are all coming from. On the one hand you claim it's about "quality patient care" but now you admit that it's about money. Cmon.
Until then, you can continue to think what you want. You can continue to drink the kool-aid put out by the AAO saying that reckless, untrained ODs just want to run around slicing and zapping random, helpless, unsuspecting patients indiscriminantly all while maniacally laughing about all the money we're going to be raking in.
Again....I really should have known better than to try to engage medical students in this discussion.
Damn we (MED STUDENTS) are slick. We fooled you yet again into having this conversation...
Lots of ASSUMPTIONS here dear sir. Not everyone is as clueless as you were at this stage of the game. You, and any other OD who wants "expansion of scope of practice" (translation: SURGICAL procedures and LASERS) have ONE thing on their mind -----> MONEY.
You should take some pointers from Ben Chudner, OD and a poster named "hello07" (Optometrist). You might learn a thing or two...
I have an idea. We close down all optometry schools and simply allow ophthalmologists to provide complete eye care. Problem solved.
I stand by my idea. Why do we need ODs? What is the problem with closing all OD schools and increasing the number of OMD residency spots? It seems like this would solve many problems. Patients would have access to more eye care physicians who could treat almost all eye issues. Residency would be become less competitive due to the increased spots.
Pay would stay the same since OMDs would replace ODs (not on a 1:1 ratio, but enough to keep salaries stable).
I know you don't like the idea, but if you can come up with one that's better for not only patients, but the folks involved in eye care, I'm all ears.
And they cut and paste the same LAME A$$ reply no matter what the question asked.
I think if you listen to what KHE is saying you will realize that he is not pushing for expanded scope and has a fairly good grasp of the situation.Damn we (MED STUDENTS) are slick. We fooled you yet again into having this conversation...
Lots of ASSUMPTIONS here dear sir. Not everyone is as clueless as you were at this stage of the game. You, and any other OD who wants "expansion of scope of practice" (translation: SURGICAL procedures and LASERS) have ONE thing on their mind -----> MONEY.
You should take some pointers from Ben Chudner, OD and a poster named "hello07" (Optometrist). You might learn a thing or two...
any optomitrist who says doing procedures is about anything but money is lying through their teeth
I've told you guys about 47 times that it IS about money. It's about money on BOTH sides.
But the mistake you're making is thinking that it's about money from performing the procedures themselves. That's not what we care about. How much money does medicare or blue cross reimburse for a chalazion removal? $100? $150? I see maybe 2 a month. I'm going to fight and lobby and bicker over $300? I could sell one extra pair of glasses a month and make the same $300 without all the time, money and energy wasted on political lobbying crap-o-la.
I've told you guys about 47 times that it IS about money. It's about money on BOTH sides.
But the mistake you're making is thinking that it's about money from performing the procedures themselves. That's not what we care about. How much money does medicare or blue cross reimburse for a chalazion removal? $100? $150? I see maybe 2 a month. I'm going to fight and lobby and bicker over $300? I could sell one extra pair of glasses a month and make the same $300 without all the time, money and energy wasted on political lobbying crap-o-la.
Do you have any idea how much a yag cap reimburses? It's like $200-$300, and I bet the average OD refers out less than 3 a month. After paying for the laser, there isn't much money left each month for profit. Even the local cataract surgeon has told me it's not worth it for him to keep the laser anymore because of the cost of maintenence vs. the low reimbursement, and he sees far more yag patients in a year than any OD ever will. He only keeps it as a service to his pseudophakic patients. While I personally believe OD's can safely perform these procedures (and have done so in Oklahoma for several years), there is no financial reason for us to do so.But it IS about $$$. Maybe not the less-than-sexy chalazion removals but the lasers that you guys are also fighting for. Theres even talk in the OD forum about anterior segment SURGERIES. Are you freakin kidding me!
Finally someone admits that at least some of the opposition is based on money.The Solution is NOT stealing french fries from the ophthalmology dinner plate!
it is not about the money only if you read the second post you will understand that it is also about ppl doing WHAT THEY ARE TRAINED AND LICENCED TO DO, I DO NOT THINK you will disagree about the HUGE difference in training between the two fields.
if optomitrists cannot see that, they should switch careers, I think we all need to know our limits, I do not see ophthalmologists doing whipples, so why do you think u have the right or even a consideration to do something you were never trained for, if you really care about patients then let someone who has extensive training do that kind of care, I bet you deep down inside you would not want someone who had never been trained to do a procedure do it on you.
But it IS about $$$. Maybe not the less-than-sexy chalazion removals but the lasers that you guys are also fighting for. Theres even talk in the OD forum about anterior segment SURGERIES. Are you freakin kidding me!
And lets just say you get to do chalazion removals in all 50 states. No biggie, right? Then you'll (maybe not "you" but other ODs) want lasers. Then "minor" surgeries. Then not-so-minor surgeries. Then what? Cataract surgery? And then!
This madness needs to stop. I understand that optometry, as a profession, is facing many challenges -- One of which is declining salaries. But WE ALL ARE. The solution is NOT stealing french fries from the ophthalmology dinner plate!
Hey does anyone know where Saib is going for Ophtholmology training? Please feel free to PM me if you like.
Thanks
This forum is for INTELLIGENT conversation.
Besides I've already replied to your ridiculous comment in the OD forum.
Now get!
That's obviously not true, they let you in.
Hey does anyone know where Saib is going for Ophtholmology training? Please feel free to PM me if you like.
Thanks
That's obviously not true, they let you in.
I'm old enough to know how to handle an obnoxious bully like Saib.
I think this whole argument is a short one...people finish training with a certain scope of knowledge and hospital privileges...the concern is not about the MINOR minor procedures... it's about the fact that if minor surgeries are allowed, this may form the impetus to allowing the scope of ODs to continually expand into less minor, then possibly major surgeries (which are DEFINATELY Ophthalmology realms, they did the 3 year residency and often a 1-2 year fellowship following)...it's not that ANYONE thinks an OD isnt competent to remove chalazions...but give a little and a big fear is that you may lose a LOT in the long run, at least that's my understanding
whether it's financial or patient safety that concerns people is up to the individual to decide
for instance, technically ENT and Oculoplastic surgeons could overlap each other in their areas of expertise since massive trauma and orbital reconstruction often involve sinuses...but Oculoplastics surgeons are not trying to expand their scope into being orbital and sinus surgeons...they probably COULD take care of these things with proper training, but they recognize the scope of their practice...
is this the BEST example in the world? probably not...but I think all this fighting isnt really getting anyone anywhere
Good point, and thank you for your calm, rational response. It's refreshing.
This is a point worth discussing. I keep hearing that allowing any increase in scope opens the door for further expansion and therefore no increase should be allowed. That assumes that OD's are less able to recognize their limits than MD's are. We don't see family practice docs performing cataract surgery not because they cannot legally, but because they know their limitations. Is it so hard to believe that OD's know their limitations? Do you really think that in this law suit happy world we live in that any OD would attempt a procedure such as cataract surgery without the proper training? I am not for surgical rights for OD's, but I find the idea that OD's are just licking their lips waiting to rush into the OR laughable. In my opinion, the reason OD's continue to push for exapanded scope is to make sure that the law allows them the ability to utilize new pharmaceuticals and procedures within their ability without having to fight legislatively. In other words, we want to eliminate fomulary type laws that do not allow for new technology to be immediately available to us. Unfortunately, in order to get what we want, it is easier to ask for much more and negotiate down.for instance, technically ENT and Oculoplastic surgeons could overlap each other in their areas of expertise since massive trauma and orbital reconstruction often involve sinuses...but Oculoplastics surgeons are not trying to expand their scope into being orbital and sinus surgeons...they probably COULD take care of these things with proper training, but they recognize the scope of their practice...
This is a point worth discussing. I keep hearing that allowing any increase in scope opens the door for further expansion and therefore no increase should be allowed. That assumes that OD's are less able to recognize their limits than MD's are. We don't see family practice docs performing cataract surgery not because they cannot legally, but because they know their limitations. Is it so hard to believe that OD's know their limitations? Do you really think that in this law suit happy world we live in that any OD would attempt a procedure such as cataract surgery without the proper training? I am not for surgical rights for OD's, but I find the idea that OD's are just licking their lips waiting to rush into the OR laughable. In my opinion, the reason OD's continue to push for exapanded scope is to make sure that the law allows them the ability to utilize new pharmaceuticals and procedures within their ability without having to fight legislatively. In other words, we want to eliminate fomulary type laws that do not allow for new technology to be immediately available to us. Unfortunately, in order to get what we want, it is easier to ask for much more and negotiate down.
This is a point worth discussing. I keep hearing that allowing any increase in scope opens the door for further expansion and therefore no increase should be allowed. That assumes that OD's are less able to recognize their limits than MD's are. We don't see family practice docs performing cataract surgery not because they cannot legally, but because they know their limitations. Is it so hard to believe that OD's know their limitations? Do you really think that in this law suit happy world we live in that any OD would attempt a procedure such as cataract surgery without the proper training? I am not for surgical rights for OD's, but I find the idea that OD's are just licking their lips waiting to rush into the OR laughable. In my opinion, the reason OD's continue to push for exapanded scope is to make sure that the law allows them the ability to utilize new pharmaceuticals and procedures within their ability without having to fight legislatively. In other words, we want to eliminate fomulary type laws that do not allow for new technology to be immediately available to us. Unfortunately, in order to get what we want, it is easier to ask for much more and negotiate down.
Fair questions, yet you are missing some info. I don't have the actual dates, but I can tell you that we have been managing glaucoma medically in Washington State for as long as I have practiced here (since 1998). In Florida, I was able to do the same in 1997. I am sure someone can give you a link which will detail the exact year in which OD's were granted that ability, but as you can see it is at least a decade in some states. Foreign body removals have been allowed for at least that long in most states.I'm on "detention" so I'm going to keep this one kosher...
Sir, my question to you is -- Why are you guys so bent on being able to medically manage glaucoma? Why now? Why the push for minor surgeries (i.e. FB removal)?
Could it have something to do with the overall decrease in your salaries?
I mean I'm just asking...
Hey does anyone know where Saib is going for Ophtholmology training? Please feel free to PM me if you like.
Thanks
DOCTORSAIB, to put it politely, you are a jerk......There is my differential diagnosis you overinflated wanna be. I am in optometry school where there is a medical school (albeit a DO school---matriculation GPA in 2005 and 2006 nationally was equal for optometry and osteopathic medicine both at 3.43 and 3.44 respectively--source www.opted.org and american association of colleges of osteopathic medicine) and take the same number of hours as the DO program and the Dental program. WE ALL WORK EQUALLY HARD! get your head out of your collective a s ses DOCTORwannabeSAIB and Happy Ophtho. We have the most conceptually difficult subject (the visual system) for 4 years! I helped some of those DO students with neuroanatomy and gross anatomy because of my educational experience. I study 50 hours a week outside of class you *****s! And by the way I have NO problem with optometry getting surgery after reading posts like yours (even though that is not the reason why I went into this.) I am very comfortable with the fact that doctors of optometry provide 75% of the primary eye care in this country and are most patients' eye doctors most of the time.
And by the way I have NO problem with optometry getting surgery after reading posts like yours (even though that is not the reason why I went into this.)
DOCTORSAIB, to put it politely, you are a jerk......There is my differential diagnosis you overinflated wanna be. I am in optometry school where there is a medical school (albeit a DO school---matriculation GPA in 2005 and 2006 nationally was equal for optometry and osteopathic medicine both at 3.43 and 3.44 respectively--source www.opted.org and american association of colleges of osteopathic medicine) and take the same number of hours as the DO program and the Dental program. WE ALL WORK EQUALLY HARD! get your head out of your collective a s ses DOCTORwannabeSAIB and Happy Ophtho. We have the most conceptually difficult subject (the visual system) for 4 years! I helped some of those DO students with neuroanatomy and gross anatomy because of my educational experience. I study 50 hours a week outside of class you *****s! And by the way I have NO problem with optometry getting surgery after reading posts like yours (even though that is not the reason why I went into this.) I am very comfortable with the fact that doctors of optometry provide 75% of the primary eye care in this country and are most patients' eye doctors most of the time.
Fair questions, yet you are missing some info. I don't have the actual dates, but I can tell you that we have been managing glaucoma medically in Washington State for as long as I have practiced here (since 1998). In Florida, I was able to do the same in 1997. I am sure someone can give you a link which will detail the exact year in which OD's were granted that ability, but as you can see it is at least a decade in some states. Foreign body removals have been allowed for at least that long in most states.
I don't think this is a new push. I am not politically active, so I can't speak to the motivation of the PAC's of each state. All I can say is that in every optometry school OD's are trained to treat glaucoma medically and have done so sucessfully, in the states that allow it, for a very long time. You will hear stories of OD's holding on to patients too long before referring to a glaucoma specialist, but I have seen plenty of non-glaucoma specialist OMD's do the same both in my residency and in my first job with a glaucoma specialist. There are less than competent providers in both professions.Thanks Doc but why the push for all 50 states now?
And are you saying that money is not a factor at all?
But it IS about $$$. Maybe not the less-than-sexy chalazion removals but the lasers that you guys are also fighting for. Theres even talk in the OD forum about anterior segment SURGERIES. Are you freakin kidding me!
And lets just say you get to do chalazion removals in all 50 states. No biggie, right? Then you'll (maybe not "you" but other ODs) want lasers. Then "minor" surgeries. Then not-so-minor surgeries. Then what? Cataract surgery? And then!
This madness needs to stop. I understand that optometry, as a profession, is facing many challenges -- One of which is declining salaries. But WE ALL ARE. The solution is NOT stealing french fries from the ophthalmology dinner plate!
Just when did D.O.s start practicing opHthalmology?
I have a very busy private practice, and enjoy a great relationship with the local MDs. There is one OMD in my area, and we get along fine. I find it amusing that OMDs on this forum are concerned about ODs gaining surgical privlages. Other than foriegn body removal, I have absolutely no interest in performing surgery. There simply isn't the demand for ODs to fill any sort of surgical niche. There are plenty of OMDs who care available and quite willing to take any and all referrals sent their way. I am already about as busy providing primary eye care as I really care to be. I make plenty of money. I can't even imagine spreading myself more thin, by adding surgery to my plate.
Optometry is an awesome profession....it doesn't need to be ophthalmology
Good point, and thank you for your calm, rational response. It's refreshing.
Just when did D.O.s start practicing opthalmology?
why are ODs asking for all surgical rights short of general anesthesia?
I think the fear, justified or not, is the fact the OD schools are cranking out graduates and they will need to find a job somewhere. Expanding scope, ie surgery, would allow the school to keep feeding the machine and making money for themselves. Lastly, in case one thinks surgery is a way to make $$, about 30% of ophthalmologist income is from surgery, which is exactly opposite what it was 10 years ago.
DOCTORSAIB,
I think killbill2 probably is a student from a foreign country with english probably being his second language.