I gave a lot of thought about whether I wanted to respond to this thread, because like many OD-MD threads, this one has the potential to become a flame-fest. I'll do my best to keep it room temperature, and hope those who respond can continue in this spirit.
Before I dive into the substance, I'll go over my creditials again, so that you know the perspective from which I am composing this response. Some of you already know my story, as I have been on the SDN scene for quite a while. I was an optometrist for 3 yrs, then went to med school, and am now in the midst of my intern year, and will start ophthalmology residency next summer.
Medical education, as we know it in this country, consists of a minimum of 4 yrs med school + 1 yr internship. This 5 yrs then qualifies one to be licensed as a physician. Nearly all physicians then continue on with residency training into a specific specialty. Once upon a time, physicians would stop their training at the 5 yr point and be a general practitioner, but things are different now. Practically speaking, many physicians actually begin their specialty training during their intern year. Pediatrics, Ob-Gyn, Internal Medicine, Surgery all have their own specific intership curricula that are more directed toward their specialty (but still involves spending time outside of their primary specialty). Ophthalmology is an extremely specialized and focused medical specialty (no pun intended, but couldn't think of a better word to use). I agree that most ophthalmologists are not routinely practicing as obstetricians. But then again, neither are ENT surgeons, orthopedic surgeons, vascular surgeons, general surgeons, pediatricians, internists, nephrologists, neurosurgeons, gastroenterologists, or psychiatrists. So why do all physicians go through Ob-Gyn rotations as med students, and learn how to deliver babies? There is a foundation of knowledge and experience that is fundamental to all physicians, even if the scope of that knowledge is not all directly part of the specialty practiced by that physician. In medical education, there is continuum that begins with didactic instruction in physiology/pathology/pharmacology, progresses to physical examination skills, and eventually progresses to clinical examination and management of patients with disease or who at at risk for disease of that system(s). Didactic instruction in anatomy, physiology, and pathology is not sufficient. At some point, you need to actually manage patients and their diseases to truly complete the process of "learning." And since one must completely "learn" a fundamental knowledge base in order to become a physician, medical education must therefore involve actual clinical management outside of the scope of what will eventually become the physician's primary specialty. I guess it's difficult to appreciate the necessity of all of the education that goes into becoming a physician without experiencing it first hand. I am not trying to say "It's and MD thing, you wouldn't understand." Rather, I am trying my best to help you understand. Ophthalmology, although a rather focused specialty (again with the unintended pun), touches a lot more than the eye. Ophthalmologists get consulted by inpatient services (general medicine/peds wards, ICU, NICU, etc). It would be difficult to walk onto a ward or a unit and be able to appreciate the complexities of the service or the patients without having worked on a ward/unit and managed those types of patients. Also, patients come to ophthalmology clinics with other diseases beyond their eyes disease. Again, you have a greater understanding of the disease process and how it affects your primary specialty (in this case, the eye/orbit/visual pathway) if you have actually managed that disease process as part of your education. This is not to say that optometrists know nothing about systemic disease. But I can say with the confidence that comes only with experience that my knowledge of many systemic diseases is much greater now that I have managed these disease processes. It's one thing to learn about diabetes and the ocular and systemic complications from books and lectures. Managing and treating patients with diabetes in a clinical context (not as an ophthalmologist, but actually managing these disease itself, including medication dosing, compiance, and psychosocial issues) provides greater understanding and knowledge of the disease. I could go on, but hopefully this example is sufficient.
Optometry education is broad in the didactic realm (physiology, pathology, pharmacology), but in the clinical realm the only experience in optometric education involves taking care of patients within the scope of what a fully trained optometrist does. While many optometry students have opportunities to shadow and observe ophthalmologists or physicians of other specialties, this is not equivalent to clinically managing those patients. I do not believe that optometry students need these experiences in order to be good optometrists. But I do believe that to be an ophthalmologist, one needs to have the fundamental core of education and training to become a physician. Thus, I believe that if one wanted to unite the two professions, the only feasible and responsible way to do this would be to eliminate optometry and roll all of it into ophthalmology. I don't advocate this solution-- I think there is a unique demand and a role for both professions. Just because the two sides find it hard to get along does not mean that either of these professions should be eliminated.