Do you think ophthalmology and optometry can become one program?

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SightIsPrecious

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These are two different programs, do you guys think that someday they can merge into one, and eye care can be all on its own? Training in medicine is no doubt important for treating systemic-related eye conditions or surgery, but are all parts of med school training today necessary for eye care? To all the ophthos who read this forum: do you think that all 4 yrs of your med school degree is helpful in your day-to-day patient care? An Eye MD can deliver babies if they really wanted to… b/c he/she went through 4 yrs of study about all parts of the body, but no one would go to an ophthalmologist to get their baby delivered. Couldn’t general medicine education be cut down a few and eye-specific education increased instead?

IF I had the power to change the eye care profession and education today, I would make the first 2 yrs full-time systemic education and the next 3-6 yrs full-time vision and eye health education/residency depending on the area of interest. For example, A primary eye care physician can go through 3 yrs of eye-specific training on top of the 2 yrs systemic ed, a corneal specialist can go through 4 yrs eye + 2 yrs systemic, a retinal specialist can go through 5-6 yrs of eye + 2 yrs systemic, etc. I think it’s better time spent for the level of eye care patients need. For optometrists who are interested in expanding the scope of practice: doesn’t it make sense to add more years of training in order to expand the scope? This kind of system makes sense to me… more eye-specific education. And if a primary eye care physician wants to enter into surgery, they can go through yet more years in training for the specialty of interest. One program for all. What do you guys think?

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Prior to the 1970's, ODs weren't able to use DPAs and TPAs. It may not seem like it to you, but if you think about it, that was a huge breach into the OMD's perimeter. Now it's everyday practice to use such drugs. So basically I think it's definitely possible as long as there's support (i.e. the AOA). But honestly we need to mobilize a huge majority of the optometrists out there to make any kind of progress, if that's even possible.
 
These are two different programs, do you guys think that someday they can merge into one, and eye care can be all on its own? Training in medicine is no doubt important for treating systemic-related eye conditions or surgery, but are all parts of med school training today necessary for eye care? To all the ophthos who read this forum: do you think that all 4 yrs of your med school degree is helpful in your day-to-day patient care? An Eye MD can deliver babies if they really wanted to… b/c he/she went through 4 yrs of study about all parts of the body, but no one would go to an ophthalmologist to get their baby delivered. Couldn’t general medicine education be cut down a few and eye-specific education increased instead?

IF I had the power to change the eye care profession and education today, I would make the first 2 yrs full-time systemic education and the next 3-6 yrs full-time vision and eye health education/residency depending on the area of interest. For example, A primary eye care physician can go through 3 yrs of eye-specific training on top of the 2 yrs systemic ed, a corneal specialist can go through 4 yrs eye + 2 yrs systemic, a retinal specialist can go through 5-6 yrs of eye + 2 yrs systemic, etc. I think it’s better time spent for the level of eye care patients need. For optometrists who are interested in expanding the scope of practice: doesn’t it make sense to add more years of training in order to expand the scope? This kind of system makes sense to me… more eye-specific education. And if a primary eye care physician wants to enter into surgery, they can go through yet more years in training for the specialty of interest. One program for all. What do you guys think?

Oh boy.... I can see where this one is going to go.

And I'm really glad that you don't have the power to change the eye care profession and education today because if you are really a pre-optometry student as your profile has suggested, then you are nowhere close enough to having anywhere near an adequate frame of reference on these issues to even think of offering up an opinion.
 
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Oh boy.... I can see where this one is going to go.

And I'm really glad that you don't have the power to change the eye care profession and education today because if you are really a pre-optometry student as your profile has suggested, then you are nowhere close enough to having anywhere near an adequate frame of reference on these issues to even think of offering up an opinion.
Scary...you took the words right out of my mouth.
 
SightIsPrecious,

(MY RESPONSE IS NOT SPELL CHECKED---in a hurry!)
I have to say what you suggest is innovative and makes a hell of a lot of sense. (I am cringing because of the ensuing backlash that is sure to come on here! lol) I am early in my optometric education and considerably older than the average optometry student so I have an "open mind." I have had a course in the "history of optometry" and done some considerable research (for about a year) when I worked in the field before attending OD School. From 1970 and on the Optometry profession has had hundreds of legal battles, legislative actions, in all 50 states to secure DPA's (Diagnostic Pharmaceutical Agents) and TPA's Therapeutic Pharmaceutical Agents) with every state currently having Oral Medications with the exception of Florida, Illinois, and I believe a couple other states. Medicine (specifically Ophthalmology) would like nothing better than OD's to be refracting opticians and not the Optometric Physicians they currently are. At an organizational level these professions absolutely hate each other. At the practioner level it depends but OD's and OMD's many times cooperate for the sake of business-----or if I want to put it with a sugar coating "the benefit of the patient.":D--not to say they are not genuinely caring OD's and OMD's----> there definitely are but business is business. Your points I believe have great merit----look at 5 and 6-yr Ophthalmology programs in Europe and Japan---it can be done. Practitioners get endoctrinated in their respective professions and your idea would not be well recieved by most OD's or OMD's. If you recommend something that involves drastic change----> Ophthalmology gets defensive and feels, "OH you CANNOT abbreviate our 8 years of training----you will blind people (1970's they said OD's would blind patients with Atropine, now in response to an optometric surgical bill that PASSED in New Mexico they stopped running ads of "OD's learning surgery over dinner---using farm animals)----they really want to maintain foothold on turf, prestige, and money. Optometry would think that you were implying that you were trying to move too far away from its roots in optics and --->"you should just go to medical school if you want to do that!" I LOVE Optometry but I realize that change is enevitable and very slow. I am very happy with Optometry the way it is now BUT I would "go with the flow" if a big change occured. Professional Evolution is good. Don't feel bad that the other posters on here "blew you up" because you are thinking and that is great. ;)


PS: Before anyone responds and says "your not even finished with OD school yet and you have no idea"-------- WRONG. I worked in the field for a few years in several settings at different positions I GET IT. A Sportscaster like Al Michels can know a considerable amount about the NFL and have never played in it! Or a professor can make comments about what is important in our OD future without being an OD.
 
These are two different programs, do you guys think that someday they can merge into one, and eye care can be all on its own? Training in medicine is no doubt important for treating systemic-related eye conditions or surgery, but are all parts of med school training today necessary for eye care? To all the ophthos who read this forum: do you think that all 4 yrs of your med school degree is helpful in your day-to-day patient care? An Eye MD can deliver babies if they really wanted to… b/c he/she went through 4 yrs of study about all parts of the body, but no one would go to an ophthalmologist to get their baby delivered. Couldn’t general medicine education be cut down a few and eye-specific education increased instead?

IF I had the power to change the eye care profession and education today, I would make the first 2 yrs full-time systemic education and the next 3-6 yrs full-time vision and eye health education/residency depending on the area of interest. For example, A primary eye care physician can go through 3 yrs of eye-specific training on top of the 2 yrs systemic ed, a corneal specialist can go through 4 yrs eye + 2 yrs systemic, a retinal specialist can go through 5-6 yrs of eye + 2 yrs systemic, etc. I think it’s better time spent for the level of eye care patients need. For optometrists who are interested in expanding the scope of practice: doesn’t it make sense to add more years of training in order to expand the scope? This kind of system makes sense to me… more eye-specific education. And if a primary eye care physician wants to enter into surgery, they can go through yet more years in training for the specialty of interest. One program for all. What do you guys think?


Most of us know that this makes way too much sense to ever work. We'll just keep arguing and bickering to grab as much of the almighty dollar as possible. To me, the basic sciences that are similarly loaded into Optometry, med school, and dentistry are a complete redundant waste of time. These are already pre-reqs. Residencies and Fellowships are fancy words for apprenticeships.

Spend less time learning more about what you will actually be doing? That's crazy talk.

Instead of my 4 years of OD school and extra year of fellowship/residency, I would rather have had 3 years of OD school and 2 years of fellowship/residency. Learning how to listen for different heart conditions with a stethoscope has really paid off!
 
SightIsPrecious,


PS: Before anyone responds and says "your not even finished with OD school yet and you have no idea"-------- WRONG. I worked in the field for a few years in several settings at different positions I GET IT. A Sportscaster like Al Michels can know a considerable amount about the NFL and have never played in it! Or a professor can make comments about what is important in our OD future without being an OD.

Well....here comes the backlash.

The fact that Al Michaels might know a lot about football doesn't mean that we are going to make him the head coach of a football team.

The argument that you have some experience in the industry simply doesn't hold water. Simply because you have worked around some doctors in the past does not in any way qualify you to offer up an opinion as to what their training or scope of practice should be anymore than a flight attendant for Continental Airlines is qualified to offer up an opinion on how many flight hours a pilot needs to be certified to fly a 747.

Let me suggest that you at least get through your training before you start offering up suggestions on how to change it.
 
Let me suggest that you at least get through your training before you start offering up suggestions on how to change it.

the only people qualified (IMHO) to make a decision are people that have gone through both programs, that teach both programs, or are involved in designing the curriculum for these programs. there are just too many factors that just comparing the syllabus or credit hours isnt enough.


and of course, itll never happen, optometry will be dead before opth and optometry get together (friends or program wise :laugh:)
 
Oh boy.... I can see where this one is going to go.

And I'm really glad that you don't have the power to change the eye care profession and education today because if you are really a pre-optometry student as your profile has suggested, then you are nowhere close enough to having anywhere near an adequate frame of reference on these issues to even think of offering up an opinion.

My "frame of reference" is based (solely) off of working for ODs and OMDs in a large private practice setting. OMD sees consults for surgeries only, and ODs in our office see all triaged walkin patients: whether they are flashes and floaters, FB, blunt eye trauma, uveitis, etc. That made me wonder how much information from Med school is used in everyday eyecare... and if someday there could be a continuous program from primary to surgical eye care.

I wonder what your opinion would've been if my profile did not say "pre-optomery"?
 
I agree with you. They act as if you know nothing about optometry at all. Because of my 3 years of experience in the field I feel like I have a solid grasp on what optometry is about. I am in OD school and it seems as if my predispositions about the field from my experiences have just been reinforced more. That said I love the field and I am excited to go to school!
 
My "frame of reference" is based (solely) off of working for ODs and OMDs in a large private practice setting. OMD sees consults for surgeries only, and ODs in our office see all triaged walkin patients: whether they are flashes and floaters, FB, blunt eye trauma, uveitis, etc. That made me wonder how much information from Med school is used in everyday eyecare... and if someday there could be a continuous program from primary to surgical eye care.

I wonder what your opinion would've been if my profile did not say "pre-optomery"?

But again....to use the same analogy,

Having worked around some doctors and watching them in action doesn't in any way qualify you to offer up an opinion on what their training or scope of practice should be any more than a flight attendent is qualified to offer up an opinion on what kind of training a pilot needs to operate a 747...even if he or she has been a flight attendant on a 747 for 3 years.

If your profile didn't say pre-optometry, my opinion would have been:

"What the hell is this guy thinking?"

Knowing that you are a pre-optometry student, my opinion is:

"What the hell is this guy thinking? He should really know better."
 
I agree with you. They act as if you know nothing about optometry at all. Because of my 3 years of experience in the field I feel like I have a solid grasp on what optometry is about. I am in OD school and it seems as if my predispositions about the field from my experiences have just been reinforced more. That said I love the field and I am excited to go to school!

Your posting history says that you were waitlisted in May. That means that if you were admitted somewhere, you are just starting. How can your "predispositions about the field from your experiences be reinforced more" now that you are in school?

How long have been in school? 3 days?

Cmon. Let's be serious now. Please.....consider completing your training (or at the very least getting through your first year :rolleyes:) before you start offering up suggestions on how to change it.
 
These are two different programs, do you guys think that someday they can merge into one, and eye care can be all on its own? Training in medicine is no doubt important for treating systemic-related eye conditions or surgery, but are all parts of med school training today necessary for eye care? To all the ophthos who read this forum: do you think that all 4 yrs of your med school degree is helpful in your day-to-day patient care? An Eye MD can deliver babies if they really wanted to… b/c he/she went through 4 yrs of study about all parts of the body, but no one would go to an ophthalmologist to get their baby delivered. Couldn't general medicine education be cut down a few and eye-specific education increased instead?

IF I had the power to change the eye care profession and education today, I would make the first 2 yrs full-time systemic education and the next 3-6 yrs full-time vision and eye health education/residency depending on the area of interest. For example, A primary eye care physician can go through 3 yrs of eye-specific training on top of the 2 yrs systemic ed, a corneal specialist can go through 4 yrs eye + 2 yrs systemic, a retinal specialist can go through 5-6 yrs of eye + 2 yrs systemic, etc. I think it's better time spent for the level of eye care patients need. For optometrists who are interested in expanding the scope of practice: doesn't it make sense to add more years of training in order to expand the scope? This kind of system makes sense to me… more eye-specific education. And if a primary eye care physician wants to enter into surgery, they can go through yet more years in training for the specialty of interest. One program for all. What do you guys think?

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.
 
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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.

my hat's off to you!

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.

well said.

i think that your experience as both an optometrist, and now a future opthamologist is invaluable to this thread.

as an internist, i get consults from opthamologists in the hospital, and in the outpatient setting. however, i still send patients to the optometrist as well. it all depends on what i think the patient needs.

i think i have a health respect for both professions, having gone to college with people who went into both fields, and i think they should and will remain as two distinct fields.

/ my 2 cents as an outsider looking in.
 
Wait i get to use my favorite smiley!
I'm using this every time the OD/OMD battle comes up.

catfight.gif
 
I have to admit I do like a good argument! And the way optometry's scope is rightfully growing, to match the training OD's have recieved and what I have started to recieve, along with academic expansion running concurrently with it, there will be many many wonderful arguments to be had with ophthalmology and medicine in the near and distant future. Hoooray:hardy:
I have a family FULL of MD's not unlike a few of my classmates and believe me when I say that ANYTHING remotely resembling what they did in "Medical School" and medical residency used by a non-allopathic-osteopathic doctor such as OD's, DPM's, and even to a lesser extend DDS's makes them collectively upset. Even my brother who is an internist is just bewildered at how I am going to have the ability to write Rx's for medications that I will be within my [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]armamentarium when I get my licence down the road in my state:
(a) topical and oral antibiotics;
(b) topical and oral antivirals;
(c) topical and oral antifungals;
(d) topical and oral antiallergy;
(e) topical and oral antiglaucoma;
(f) topical steroids;
(g) topical and oral nonsteroidal anti-inflamatory;
(h) oral non-narcotic analgesics;
(i) oral narcotic Schedule III or IV analgesics;

I actually have a couple of close family friends who are ophthalmologists and they are supportive of this prescriptive authority BECAUSE they know that I will never ever be able to do invasive ocular surgery, They are smart and understand how to benefit from being amicable with Optometric Physicians. One is an oculoplastic surgeon while the other is a lasik-cataract surgeon, and they feel that it is fine for a primary eye doctor (OD) to be able to do primary eye care....They just rack up all the referrals because they have a vast network of OD's they are business partners with. These guys rock!--when I graduate they said they will help me any way they can. I used to go to the bars with one of them in his college years...lol But like I said earlier the national and state ophthalmological organizations absolutely HATE OD's. If you look at their websites in their description of "what"an OD is, they undervalue and underepresent what an optometrist can do. Using phrases like " in some cases they can prescribe medications in some states." ??????:confused: 47 states have oral and topical prescriptive authority and all 50 have topical. Many now have injectable drugs. Ophthalmology and Medicine collectively suffer from the biggest flaw of all and that is hubris--"according to its modern usage, is exaggerated self pride or self-confidence (overbearing pride), often resulting in fatal retribution." Based on that, there will NEVER ever be any kind of amicable agreement at a national level regarding scope of practice. We will have to take it state by state for the next 20 yrs or so. I got into optometry to treat primary eye disease as well as visual problems, refractive disorders, and hmmmmm I guess-----ALOT of future arguing with ophthalmology! Life is short--enjoy it the best way you can!;):D
.




God Bless our troops who are fighting for our freedom around the world.
 
I have to admit I do like a good argument! And the way optometry's scope is rightfully growing, to match the training OD's have recieved and what I have started to recieve, along with academic expansion running concurrently with it, there will be many many wonderful arguments to be had with ophthalmology and medicine in the near and distant future. Hoooray:hardy:
I have a family FULL of MD's not unlike a few of my classmates and believe me when I say that ANYTHING remotely resembling what they did in "Medical School" and medical residency used by a non-allopathic-osteopathic doctor such as OD's, DPM's, and even to a lesser extend DDS's makes them collectively upset. Even my brother who is an internist is just bewildered at how I am going to have the ability to write Rx's for medications that I will be within my [FONT=Arial,Helvetica,Geneva,Swiss,SunSans-Regular]armamentarium when I get my licence down the road in my state:
(a) topical and oral antibiotics;
(b) topical and oral antivirals;
(c) topical and oral antifungals;
(d) topical and oral antiallergy;
(e) topical and oral antiglaucoma;
(f) topical steroids;
(g) topical and oral nonsteroidal anti-inflamatory;
(h) oral non-narcotic analgesics;
(i) oral narcotic Schedule III or IV analgesics;

I actually have a couple of close family friends who are ophthalmologists and they are supportive of this prescriptive authority BECAUSE they know that I will never ever be able to do invasive ocular surgery, They are smart and understand how to benefit from being amicable with Optometric Physicians. One is an oculoplastic surgeon while the other is a lasik-cataract surgeon, and they feel that it is fine for a primary eye doctor (OD) to be able to do primary eye care....They just rack up all the referrals because they have a vast network of OD's they are business partners with. These guys rock!--when I graduate they said they will help me any way they can. I used to go to the bars with one of them in his college years...lol But like I said earlier the national and state ophthalmological organizations absolutely HATE OD's. If you look at their websites in their description of "what"an OD is, they undervalue and underepresent what an optometrist can do. Using phrases like " in some cases they can prescribe medications in some states." ??????:confused: 47 states have oral and topical prescriptive authority and all 50 have topical. Many now have injectable drugs. Ophthalmology and Medicine collectively suffer from the biggest flaw of all and that is hubris--"according to its modern usage, is exaggerated self pride or self-confidence (overbearing pride), often resulting in fatal retribution." Based on that, there will NEVER ever be any kind of amicable agreement at a national level regarding scope of practice. We will have to take it state by state for the next 20 yrs or so. I got into optometry to treat primary eye disease as well as visual problems, refractive disorders, and hmmmmm I guess-----ALOT of future arguing with ophthalmology! Life is short--enjoy it the best way you can!;):D
.




God Bless our troops who are fighting for our freedom around the world.


Maybe I am missing something, but this thread doesn't really seem like an "argument." I have been around SDN for quite some time. I have seen some venom-spewing, name-calling, thread-closing arguments. In fact, this thread has had posts by two physicians (myself included) defending the existence of the profession of Optometry.

I have also been around long enough to know that both sides have contributed to the condition that prevents an "amicable agreement at a national level regarding scope of practice." As a side note, using inflammatory language like "exaggerated self pride" when describing physicians is not likely to start any friendly conversations.

So let's keep this friendly non-argument going.

Caffeinated
 
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.

Caffeinated,

Thank you for your response about why you believe med school education is important. I understand and agree with your reasoning to some degree… however, your point still leaves me hanging because you are not currently a practicing ophthalmologist. Your right, having 4 yrs of general ed in medicine would give anyone a better understanding of systemic conditions… but does that actually change the assessment and plan for each patient as an ophthalmologist? So if a patient has diabetes and has diabetic retinopathy, would an ophthalmologist be the one to change the patient’s insulin dosage and monitor their A1C’s or would that be the PCP/endocrinologist’s role? And if you were an ophthalmologist that specialized in glaucoma.. would you not send this patient to a retinal specialist to treat the retinopathy? This is what I have seen at least… and I know observations are not everything and I only work for one office. But ophthalmologists send consults to other ophthalmology specialists for things like retina and cornea if they are not fellowship-trained to perform procedures in that specific area. Outside of surgery, the only time that I have seen an ophthalmologist do anything different from an optometrist in monitoring and treatment, is knowing when to take a patient off of certain meds before surgery, to make sure the surgery runs smoothly and knowing when to put the patient back on those meds (which I understand is not always a simple decision). And even then, the ophthalmologist coordinates with the patient’s PCP to make sure that it is okay to take the patient off of coumadin, or whatever that’s going to be a danger for the surgery. So surgery and peri-surgical decision making is the only difference I see in the practice of both professions… and this is why I wondered why the two could not be one continuous program (of course, other than the obvious reason that many people in the two professions do not like each other).
 
Caffeinated,

I am not implying that arguing is a malignant thing all the time. I should properly restate---I like having a amicable discussion, that is the goal, but when discussing controversial issues it degrades quickly.

Regarding your statement, "defending the existence of the profession of Optometry." Optometry doesn't need to defend its exsistance to anybody, medicine or whoever. I know your response there was well intended and I appreciate it. I for one understand that "behind closed doors" a great number of Ophthalmologists deride Optometric Physicians all the time. Of course at Ophthalmology state and national organizations this is very very salient. Any OD who thinks that the Ophthalmolgy profession wants anything postitive for Optometry---THEY ARE DREAMING. I for one don't care what Opthalmology thinks or believes what OD's should do. I really don't. I will take things on an individual practitioner basis. I know who I am going to refer patients to down the road-----friends of mine who are opthalmologists who are pro-optometry (all of whom are very skilled and caring eye surgeons.) Optometry is going through many changes over the next few years and I am excited about that. Optometry is a legislated profession and will always be that way so we have to support our state and national organizations (AOA) the best we can. Come on Caffeinated, you have to understand this? I am going into optometry to be a primary eye physician and I will proudly display that on my shingle. No matter what field you enter there are going to be those that talk negatively about you whether overtly or covertly. I have a thick skin ,a great sense of humor, and will do my thing proudly:D.
 
I have also been around long enough to know that both sides have contributed to the condition that prevents an "amicable agreement at a national level regarding scope of practice." As a side note, using inflammatory language like "exaggerated self pride" when describing physicians is not likely to start any friendly conversations.

So let's keep this friendly non-argument going.

Caffeinated

Caffeinated,

Hypothetically, let's say that you did not match in ophthalmology.

Please explain for the benefit of the people on this forum in what way your medical training would help you in the non-surgical management of diabetic retinopathy or other systemic diseases that have ocular manifestations?

Or to be more concise, can you detail a little bit what it is about your expanded knowledge of the disease "diabetes" garnered through medical school that helps you better manage the manifestation "diabetic retinopathy?"
 
Caffeinated,

Thank you for your response about why you believe med school education is important. I understand and agree with your reasoning to some degree… however, your point still leaves me hanging because you are not currently a practicing ophthalmologist. Your right, having 4 yrs of general ed in medicine would give anyone a better understanding of systemic conditions… but does that actually change the assessment and plan for each patient as an ophthalmologist? So if a patient has diabetes and has diabetic retinopathy, would an ophthalmologist be the one to change the patient’s insulin dosage and monitor their A1C’s or would that be the PCP/endocrinologist’s role? And if you were an ophthalmologist that specialized in glaucoma.. would you not send this patient to a retinal specialist to treat the retinopathy? This is what I have seen at least… and I know observations are not everything and I only work for one office. But ophthalmologists send consults to other ophthalmology specialists for things like retina and cornea if they are not fellowship-trained to perform procedures in that specific area. Outside of surgery, the only time that I have seen an ophthalmologist do anything different from an optometrist in monitoring and treatment, is knowing when to take a patient off of certain meds before surgery, to make sure the surgery runs smoothly and knowing when to put the patient back on those meds (which I understand is not always a simple decision). And even then, the ophthalmologist coordinates with the patient’s PCP to make sure that it is okay to take the patient off of coumadin, or whatever that’s going to be a danger for the surgery. So surgery and peri-surgical decision making is the only difference I see in the practice of both professions… and this is why I wondered why the two could not be one continuous program (of course, other than the obvious reason that many people in the two professions do not like each other).


Great questions. I am going to give my replies to the next few posts one at at time, because there is a lot to say.

1). You're right, I am not a practicing ophthalmologist. But I am pretty darn close. Here are a few of the the roles I have assumed over the last 10 years: optometry student, a tech in an ophthalmology practice, a practicing optometrist in a hospital-based setting, a med student (including several ophtho rotations as a med student), and an intern. So you're right, I am not 100% qualified to give you the full perspective from both sides. So take my input for what it is worth. That is why I disclosed my background up front -- so the reader can assess how qualified or unqualified. I am not an unquestionable voice of authority; anyone is free to accept or reject what I say. But I think I have a unique and valuable perspective that can keep the discussion going in a productive manner.

2.) If you consider the management of one problem, then no, the plan should not change simply because I have a med school education. But comorbidity is the rule rather than the exception, and the systemic implications of these comorbidities gets complicated. The difference between an OD and an MD is that optometrists are taught, for the most part, the eye, and the pertinent systemic diseases that directly impact the visual system; physicians learn lots of systemic diseases and the acute and chronic management of multiple comorbidities before they every become ophthalmologists. So if the only problem is diabetes/retinopathy, then it's pretty straightforward. But if the patient is diabetic, they probably have hypertension also. They may be on aspirin for chemoprophylaxis for MI; they may be on Plavix because they have had a corornary stent; they may be on Coumadin for a-fib. Not all that bleeds in a diabetic eye is diabetic retinopathy. Is it hypertensive retinopathy? Is that acute exacerbation of their retinopathy really d/t an intracranial bleed? If so, what risk factors do they have for a bleed? Is their hypertension adequately controlled? Are they coagulopathic? Perhaps that acute worsening of vision is CMV, as you might seen an HIV patient, or a post-transplant patient. Would I expect CMV retinitis in a patient with this CD4 count, or does this new ocular manifestation signify a worsening of their condition? Their antiviral will probably need to be renally dosed if they chronic renal insufficiency, or if they are kidney transplant patient. These may be some of the more extreme issues, but like I said, comorbidity is common. If you are not comfortable with the range of comorbidities that can begin to impact how you manage a patient, then one can get in over their head very quickly.

3.) No, I don't expect an ophthalmologist (or an optometrist for that matter) to be messing with insulin dosing if the patietn is being managed by an internist or an endocrinologist. But if I am going to provide feedback to the physician managing their glycemic control, I am more likely to frame my feedback in a way that is meaningful to the receiving clinician if I have an understanding/clincal experience of what goes into establishing and maintaining an insulin regimen.

4.) There is a much more of a difference between OD and MD than perioperative medication changes. There is the actual surgical procedure itself(and all of the training that goes into that). I could go into more examples, but the post is getting quite long already, and I hope some of the previous examples stimulate you to start thinking more about these previously unseen differences.

Caff
 
Caffeinated,

I am not implying that arguing is a malignant thing all the time. I should properly restate---I like having a amicable discussion, that is the goal, but when discussing controversial issues it degrades quickly.

Regarding your statement, "defending the existence of the profession of Optometry." Optometry doesn't need to defend its exsistance to anybody, medicine or whoever. I know your response there was well intended and I appreciate it. I for one understand that "behind closed doors" a great number of Ophthalmologists deride Optometric Physicians all the time. Of course at Ophthalmology state and national organizations this is very very salient. Any OD who thinks that the Ophthalmolgy profession wants anything postitive for Optometry---THEY ARE DREAMING. I for one don't care what Opthalmology thinks or believes what OD's should do. I really don't. I will take things on an individual practitioner basis. I know who I am going to refer patients to down the road-----friends of mine who are opthalmologists who are pro-optometry (all of whom are very skilled and caring eye surgeons.) Optometry is going through many changes over the next few years and I am excited about that. Optometry is a legislated profession and will always be that way so we have to support our state and national organizations (AOA) the best we can. Come on Caffeinated, you have to understand this? I am going into optometry to be a primary eye physician and I will proudly display that on my shingle. No matter what field you enter there are going to be those that talk negatively about you whether overtly or covertly. I have a thick skin ,a great sense of humor, and will do my thing proudly:D.

1.) Agree -- the discussions can spiral downward very quickly. I have seen it happen quite often. But I think this one is safe for now.

2.) Regarding my comment about "defending the existence of the profession of Optometry" let me clarify. The OP posed the question about optometry and ophthalmology becoming one program. My comment about "defending the existence" is in response to the question of maintaining separate professions versus merging into one. In no way did I mean to suggest that Optometry is illegitimate, but rather my point was to say that there should be two separate professions, because both serve important roles. As an aside, I want to offer a word of caution about how your reply ("Optometry doesn't need to defend its exsistance to anybody, medicine or whoever") comes across to the reader. This sounds like a little smidge of hubris to me.

3.) I can't speak for all ophthalmologists, but I will speak for me. I, Caffeinated, simply want what is best for patients. Consider for a moment that some of the changes in optometric scope currently on the table that you consider as "positive for optometry" might not be best for patients. I am not naive, and I realize that there is financial turf at stake. Money is a powerful motivator for both sides, organized Optometry and Ophthalmology alike. But if we put the financial junk aside and have a logical, rational discussion about what is best for patients, then we will uncover areas where optometry is seeking to expand into areas that are not in the best interest of patient safety. We will also find some things that optometrists are qualified to do, and should continue to do, that ophthalmology fights against. Neither side is without fault. But the best solution that serves the most noble goals -- patient care and patient safety -- will only be achieved when both sides trust each other to serve the needs of patients above all else. I will support the role and scope of optometry to the extent that I believe the education and training permits the best care and patient safety. But if "pro-optometry" means granting whatever scope you want without questioning what is best for patients, then I cannot support that. It saddens me to think that some might consider me "anti-optometry" for that. To be honest, I think the majority of ophthalmologists would be comfortable with an optometric scope of practice that most optometrists would be very happy with. But I think there is a collective fear among ophthalmology that the momentum would not stop. And to be honest, I don't think that fear is unjustified.
 
1: What exactly is a "primary eye physician"
2: If I ever saw "primary eye physician" on a "shingle" I would laugh my balls off

I'm not a big fan of terms such as primary eye physician, optometric physician, etc. At best, it's a misnomer and misleading to the public. But I think it ultimately hurts Optometry. I'm only saying that because I care. :love:
 
Hmm, I'm not sure I understand the question. If I hypothetically consider that I did not match into ophtho, then I cannot imagine that I would be managing diabetic retinopathy. Maybe my reply a few posts above helps answer your question?

Caffeinated,

Hypothetically, let's say that you did not match in ophthalmology.

Please explain for the benefit of the people on this forum in what way your medical training would help you in the non-surgical management of diabetic retinopathy or other systemic diseases that have ocular manifestations?

Or to be more concise, can you detail a little bit what it is about your expanded knowledge of the disease "diabetes" garnered through medical school that helps you better manage the manifestation "diabetic retinopathy?"
 
Hmm, I'm not sure I understand the question. If I hypothetically consider that I did not match into ophtho, then I cannot imagine that I would be managing diabetic retinopathy. Maybe my reply a few posts above helps answer your question?

Yes, that post did help very much.

Many pre and current optometry students and certainly some ODs who are out practicing don't have an appreciation for the benefits of a med school education in the role of managing diabetic retinopathy or other systemic conditions with ocular manifestations. T

Your examples provide great help.
 
Yes KHE..........Just as much as I laughed yesterday when I saw
an Ophthalmologist that had on his shingle,

"Eye Physician and Surgeon" given your reasoning that is ridiculous as well. Joe public would get lost trying to remember that. A group of us, including some medical students chuckled when we saw that. "Why not just say Ophthalmologist?"

Optometric Physician or Eye Physician is still a hell of a lot better than

WALMART VISION CENTER
Independent Doctor of Optometry
next to the Photo Shop


Actually I probably will just put "Eye Doctor" on my shingle because that is what 95% of the public refers optometric physicians as, my optometry school refers to us as that, and most of the physicians I associate with.

Eye Doctor = Optometrist
Eye Surgeon = Ophthalmologist

KHE you and I just disagree on just about everything and that is cool! :love: I went into my optometry program in order priority to me:

1) Diagnosis and Treatment of Ocular Disease (primary care level) with medication.
2) Pre and Post Operative management of Ocular Surgery
3) Once a couple bills get passed, minor surgical procedures (like New Mexico or Oklahoma). NOT REAL INVASIVE OCULAR SURGERY
4) Rx of contacts and spectacles
5) Education----public, possibly optometric education.

I like all of those BUT in that order. My goal is to advance medical optometry or the medical aspect of it. I want to make a difference in the growth of the field and I will do an oclular disease residency upon the completion of my Optometry Doctorate. I also am looking into a degree in ocular pathology possibly an MS my last two years in school--I need help finding this. I used to be in sales and I love challenges and advancing the optometric field is a noble one.
 
Caffeinated,

Optometrists are Eye Doctors----that is a fact. So do you have a problem with that?:rolleyes:



:love:
 
Actually I probably will just put "Eye Doctor" on my shingle because that is what 95% of the public refers optometric physicians as, my optometry school refers to us as that, and most of the physicians I associate with.

Most, if not all state boards are not going to allow you to use the term "eye doctor" without specifying your degree or the fact that you are a doctor of optometry.

KHE you and I just disagree on just about everything and that is cool! :love: I went into my optometry program in order priority to me:

1) Diagnosis and Treatment of Ocular Disease (primary care level) with medication.
2) Pre and Post Operative management of Ocular Surgery
3) Once a couple bills get passed, minor surgical procedures (like New Mexico or Oklahoma). NOT REAL INVASIVE OCULAR SURGERY
4) Rx of contacts and spectacles
5) Education----public, possibly optometric education.

I like all of those BUT in that order. My goal is to advance medical optometry or the medical aspect of it. I want to make a difference in the growth of the field and I will do an oclular disease residency upon the completion of my Optometry Doctorate. I also am looking into a degree in ocular pathology possibly an MS my last two years in school--I need help finding this. I used to be in sales and I love challenges and advancing the optometric field is a noble one.

Regretably, I predict much dissapointment for you. If that is what you are interested in, you will fare much better going to medical school and becoming an ophthalmologist. I own one of the most "medically" oriented practices in my area yet refractive and vision care still make up the lions share of the patient visits. If your goal is to own a practice, you should rethink optometry if that list is truly what you are interested in. If you desire to work for an ophthalmologist, or in an institutional setting, you will probably do fine.
 
G
2.) If you consider the management of one problem, then no, the plan should not change simply because I have a med school education. But comorbidity is the rule rather than the exception, and the systemic implications of these comorbidities gets complicated. The difference between an OD and an MD is that optometrists are taught, for the most part, the eye, and the pertinent systemic diseases that directly impact the visual system; physicians learn lots of systemic diseases and the acute and chronic management of multiple comorbidities before they every become ophthalmologists. So if the only problem is diabetes/retinopathy, then it's pretty straightforward. But if the patient is diabetic, they probably have hypertension also. They may be on aspirin for chemoprophylaxis for MI; they may be on Plavix because they have had a corornary stent; they may be on Coumadin for a-fib. Not all that bleeds in a diabetic eye is diabetic retinopathy. Is it hypertensive retinopathy? Is that acute exacerbation of their retinopathy really d/t an intracranial bleed? If so, what risk factors do they have for a bleed? Is their hypertension adequately controlled? Are they coagulopathic? Perhaps that acute worsening of vision is CMV, as you might seen an HIV patient, or a post-transplant patient. Would I expect CMV retinitis in a patient with this CD4 count, or does this new ocular manifestation signify a worsening of their condition? Their antiviral will probably need to be renally dosed if they chronic renal insufficiency, or if they are kidney transplant patient. These may be some of the more extreme issues, but like I said, comorbidity is common. If you are not comfortable with the range of comorbidities that can begin to impact how you manage a patient, then one can get in over their head very quickly.

ooooo big words, but alot of these topics are discussed in optometry school and are taken into consideration by optometrists when managing patients. of course optometrist usually do not have all the testing equipment like a MD and would need to refer, as you should know, optometrist know plenty about diabetes.

i might have almost failed these classes but i know my classmates did well and with practice (and more learning) will be able to manage them just fine.
 
1) Diagnosis and Treatment of Ocular Disease (primary care level) with medication.
2) Pre and Post Operative management of Ocular Surgery
3) Once a couple bills get passed, minor surgical procedures (like New Mexico or Oklahoma). NOT REAL INVASIVE OCULAR SURGERY
4) Rx of contacts and spectacles
5) Education----public, possibly optometric education.

I like all of those BUT in that order. My goal is to advance medical optometry or the medical aspect of it. I want to make a difference in the growth of the field and I will do an oclular disease residency upon the completion of my Optometry Doctorate. I also am looking into a degree in ocular pathology possibly an MS my last two years in school--I need help finding this. I used to be in sales and I love challenges and advancing the optometric field is a noble one.

I agree with KHE here - if that list sums up all of your hopes and desires for the field, you might end up rather disappointed when your appointment book holds nothing but refractive cases with the occasional emergency or red eye thrown in (unless working with/for an OMD is ideal to you). You are entering a field saying, "OK - I'll be happy once I get x, y, and z laws passed." You should be going into optometry because you love what the field is today, not what the field could be in your perfect world.
 
Regretably, I predict much dissapointment for you. If that is what you are interested in, you will fare much better going to medical school and becoming an ophthalmologist. I own one of the most "medically" oriented practices in my area yet refractive and vision care still make up the lions share of the patient visits. If your goal is to own a practice, you should rethink optometry if that list is truly what you are interested in. If you desire to work for an ophthalmologist, or in an institutional setting, you will probably do fine.
I also believe you are setting yourself up for a lot of heartache. Just like KHE, I have the most medically orientated optometric practices in my county. Prettygreeneyes just spent the afternoon observing my clinic (by the way, she really does have green eyes). She can confirm just how many true medical exams walk through the door. I think yesterday afternoon we saw 12 patients. 10 were full exams, 1 was an amblyopia follow up and 1 was a bungee cord accident. Listen to prettygreeneyes - go into optometry for what it is now, not what you hoe it will be in the future.
 
hold on a minute here....... I do like optometry for what it is. I like EVERYTHING on that list and I just have a preference for ocular disease management. I am going to be working with an Ophthalmology practice or an institutional setting or both when I am done (family connections will make that a reality.) I am doing an eye disease residency upon completion to strengthen my skills and I plan on getting a diplomate in glaucoma management from the AAO. I will make less money and I am fine with that.
And by the way in my state as long as you have O.D. next to your name----( I called the regulatory board and checked) you can have eye doctor next to your name. You have to have OD or Optometrist somewhere next to your name or under it. I think all of you guys KHE, Dr. Chundler, and Prettygreen eyes misunderstood what I meant. I am going into optometry for what I can do in my state---period. I welcome change but I am happy with it for what it is. :)
 
I believe one of the biggest differences b/t OD training and OMD training is the # of pts. OMD's will treat during their residency . OMD's will see approx. 20,000 pts. OD's will see approx. 1500. OMD's also have to read the American Academy of Ophthalmology Basic and clinical science course , a 12 volume series of books. They must read this every year and get tested on it in april of every year. (it's a practice test for the boards ). So their depth of knowledge at least initially is greater than that of an OD. Hopefully Caff will keep us posted during his ophtho residency and let us know of some of the complicated cases he has to handle. I don't mean to sound so pro OMD but to compete I think we have to improve our training.
 
Caffeinated,

Optometrists are Eye Doctors----that is a fact. So do you have a problem with that?:rolleyes:



:love:

I have no problem with that. In fact, I can't think of anyone who would have a problem with that. When I was in med school, my classmates would joke that when I graduated they were going to call me "Doctor Doctor Caffeinated." But equating "Doctor" with "Physician" is where you might get some backlash.
 
hold on a minute here....... I do like optometry for what it is. I like EVERYTHING on that list and I just have a preference for ocular disease management. I am going to be working with an Ophthalmology practice or an institutional setting or both when I am done (family connections will make that a reality.) I am doing an eye disease residency upon completion to strengthen my skills and I plan on getting a diplomate in glaucoma management from the AAO. I will make less money and I am fine with that.
And by the way in my state as long as you have O.D. next to your name----( I called the regulatory board and checked) you can have eye doctor next to your name. You have to have OD or Optometrist somewhere next to your name or under it. I think all of you guys KHE, Dr. Chundler, and Prettygreen eyes misunderstood what I meant. I am going into optometry for what I can do in my state---period. I welcome change but I am happy with it for what it is. :)

If I did misunderstand your post, I apologize. I offer my advice up not to criticize you but rather to ensure that you are happy with your career choice. It sounds as though you have a plan put together, and I hope it works out for you. Best of luck...
 
Prettygreeneyes just spent the afternoon observing my clinic (by the way, she really does have green eyes).

:laugh:

Yep... they're green. No lies. They're pretty too, if you ask my husband. ;):oops:

In all seriousness, Dr. Chudner has a fantastic practice... I really encourage any students who are in the area to visit if at all possible. It was very neat to see some of those text book pictures in real life!
 
ooooo big words, but alot of these topics are discussed in optometry school and are taken into consideration by optometrists when managing patients. of course optometrist usually do not have all the testing equipment like a MD and would need to refer, as you should know, optometrist know plenty about diabetes.

i might have almost failed these classes but i know my classmates did well and with practice (and more learning) will be able to manage them just fine.

Yes, I am aware that these topics (and various other big words) are discussed in optometry school, and I am also aware of what goes into managing a patient as an optometrist. The point I am trying to emphasize is that didactic instruction provides a certain degree of competency. Using that knowledge to actually participate in the management of a disease process or multiple disease processes provides an even greater degree of understanding and competency. That's all.
 
Both of you will find out that without question the most anti-optometry ophthalmologists are those that had previously gone through optometry school. I'll bet some of this is a result of their coming to the realization that they spent alot of extra time and training to do very little more, and probably resent this and dare some optometrist think he/she should have similar priviliges. Just compare the breadth of what a general surgeon does to an ophthalmologist and you can see where a little insecurity would develop. To wonder if optometry and ophth will someday merge in some fashion leads me to believe someone is in a hypnotic state.

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.
 
Both of you will find out that without question the most anti-optometry ophthalmologists are those that had previously gone through optometry school. I'll bet some of this is a result of their coming to the realization that they spent alot of extra time and training to do very little more, and probably resent this and dare some optometrist think he/she should have similar priviliges.

Wow. On another forum, you claimed that optometrists don't pursue higher licensure because "it is used very little" but now here you are claiming that an optometrist turned ophthalmologist is going to be bitter because he will spend a lot of time and extra training to do very little more than an optometrist. Your logic basically says that ophthalmologists are little more than glorified optometrists and that optometrists are little more than glofified ophthalmic technicians. What the hell is up with that?

Jeff, why don't you just up and find yourself something else to do instead of just bitching and moaning all day long? Lord knows I've done my share of that but at the end of the day at least I up and did something about it and I like to think that I at least provided some suggestions on how students can make an enjoyable career for themselves in optometry without simply saying "don't do it, it sucks."

If you're that bitter as an OD, find another career! There's lots out there, even for someone who has spent 20 years in the armed forces.
 
Yes, I am aware that these topics (and various other big words) are discussed in optometry school, and I am also aware of what goes into managing a patient as an optometrist. The point I am trying to emphasize is that didactic instruction provides a certain degree of competency. Using that knowledge to actually participate in the management of a disease process or multiple disease processes provides an even greater degree of understanding and competency. That's all.

Thanks for your input, your points are very well made. I am uncertain as to why some have viewed you as anti-optometry, I dont see it that way. I began my career as a medical student, and decided after a year, to change directions. Anyone claiming there is little difference in the education of an OD and an OMD is not worth arguing with, because they clearly have lost touch with reality.

I am a long time advocate of scope expansion for OD's, however, not at the expense of what is best for the patient. ODs should not be performing surgery(and I refer to actual surgery not the bogus surgical codes like fb removal or punctal plugs, simple biopsy, chalazion removal,etc). I think many ODs feel angry that ophthalmology and organized medicine take it upon themselves to decide what we should and shouldnt do. I for one, dont like it either but I recognize the need for some oversight as the radical minority would have ODs performing vitrectomies and membrane peels- this is of course absurd. However, I do think there is some middle ground we could reach on a national level in terms of scope that would be both fair to ODs and good for patient care. Belittling ODs and making us look like opticians to our patients and the public is not the way to go.

Posner
 
I like EVERYTHING on that list and I just have a preference for ocular disease management. I am going to be working with an Ophthalmology practice or an institutional setting or both when I am done (family connections will make that a reality.) I am doing an eye disease residency upon completion to strengthen my skills and I plan on getting a diplomate in glaucoma management from the AAO. I will make less money and I am fine with that.

If you have a "preference for ocular disease managment" then you really should be considering ophthalmology.

And with all due respect to the academy (which is a fine organization) a "diplomate in glaucoma management" from the AAO will carry about as much weight and prestige as a board certifcation would for a tree surgeon or a fellowship would for a rug doctor.
 
Caffeinated,

Good Luck starting your ophthalmology residency next year. As an optometrist, I am curious to know what made you decide to apply to medical school and want to become an ophthalmologist after practicing optometry for 3 years? Did you ever feel disrespected by the public you took care of even in the hospital setting? Or was it your desire to concentrate on medicine and surgery?
Anyhow, kudos to you! for your motivation.
 
KHE,

I was affiliated in a practice (student-observer) for about a year that was affiliated with an eye hospital. The OD (who is a friend of mine) worked at both the eye hospital (as an optometric glaucoma specialiist) in the glaucoma wing and at a private practice affiliated with it. When I was there I saw a lot of ocular pathology---orbital pseudotumor, ophthalmic herpes zoster, bacterial conjunctivitis, POAG, retinal detachments, ocular trauma, FB removal---some really interesting ones, ophthalmic hepititis, diabetic retinopathy, macular degeneration, an AIDS patient, and the list goes on and on. I would say that probably 25% of the time when I was there I these types of patients would come in and it was because of the afiliation with the eye hospital and the comanagement. He Rx'd oral antivirals, a lot of Lumigen and other anti-glaucomas, oral narcotics, oral corticosteroids, along with the usual myriad of topical medications. When I say manage eye disease-----all of this afformentioned is what I am referring to. I mean manage it from a primary eye doctor perspective. As to your low opinion of the AAO's diplomates. This is a new thing and with time and optometry's advancement more and more into medical management of the eye---diplomates and special certifications will grow-----REMEMBER Dr. KHE, I will not even have a practice for 4-5 more years (OD school + 1 year residency.) I am part of a new generation of future OD's that want to expand the field and make it grow. Optometry should have its own specialties and advertise them---who cares what medicine or anyone else thinks?:rolleyes: I will get that diplomate and be proud of it. I will educate the public as to the importance and relevance to their care.:) Patience my friend patience.
 
You make some assumptions that are offbase. I still enjoy what I do on a day to day basis. I still like going to work and have fun at work. I do not necessarily like what or the way the field has become or all about it. I would not go into optometry if having to do over TODAY. I do not like the negative tone, patronizing that some in ophth engage in. Why would I just up and find something else to do? Your assessment of my "logic" is wrong and assumes that which is wrong. Maybe you are the one that needs to find something else to do!! Certainly recommending to others is not a field you should consider.

Wow. On another forum, you claimed that optometrists don't pursue higher licensure because "it is used very little" but now here you are claiming that an optometrist turned ophthalmologist is going to be bitter because he will spend a lot of time and extra training to do very little more than an optometrist. Your logic basically says that ophthalmologists are little more than glorified optometrists and that optometrists are little more than glofified ophthalmic technicians. What the hell is up with that?

Jeff, why don't you just up and find yourself something else to do instead of just bitching and moaning all day long? Lord knows I've done my share of that but at the end of the day at least I up and did something about it and I like to think that I at least provided some suggestions on how students can make an enjoyable career for themselves in optometry without simply saying "don't do it, it sucks."

If you're that bitter as an OD, find another career! There's lots out there, even for someone who has spent 20 years in the armed forces.
 
As to your low opinion of the AAO's diplomates. This is a new thing and with time and optometry's advancement more and more into medical management of the eye---diplomates and special certifications will grow
Diplomates are not new, although glaucoma may be. The truth is that not many people go for their diplomate because in private practice it is meaningless. Most, if not all, diplomates are in academia which is really where they belong. Furthermore, the Academy is becomming increasingly less relevant. There was a time when it was an honor to put FAAO after your name. Now, the requirements are so easy, anyone can become a fellow.
I am part of a new generation of future OD's that want to expand the field and make it grow.
Actually, the consensus is that the future optometrist is a female that wants to work part time. There is nothing wrong with that, but please don't think that the new generation of future OD's is any more motivated to grow the profession of optometry.
Optometry should have its own specialties and advertise them---who cares what medicine or anyone else thinks?
I couldn't disagree with this more. Some specialties are fine such as binocular vision or contact lenses, but no OD should claim to be a specialist in disease management like glaucoma or retina.
I will get that diplomate and be proud of it.
You should be proud of it. Diplomates are difficult to get. They are irrelevant, but they are still difficult.
 
. Diplomates are difficult to get. They are irrelevant, but they are still difficult.

This is true. Your patients aren't going to know what that FAAO means any more than they truly understand what an OD actually does. If you're not out in academia or corporate research, get the FAAO because you, personally, feel it's important. Because, honestly, your patients could care less.
 
Both of you will find out that without question the most anti-optometry ophthalmologists are those that had previously gone through optometry school. I'll bet some of this is a result of their coming to the realization that they spent alot of extra time and training to do very little more, and probably resent this and dare some optometrist think he/she should have similar priviliges. Just compare the breadth of what a general surgeon does to an ophthalmologist and you can see where a little insecurity would develop. To wonder if optometry and ophth will someday merge in some fashion leads me to believe someone is in a hypnotic state.

Well, I will stay tuned to SDN so the folks here can track my attitude as I progress through residency. This will either prove your point, or I will be the exception.

I can't comment on the etiology of the attitudes of the OD-turned ophtho people you have met. I haven't had your experiences, and I have not met those people of whom you speak. Perhaps their attitude was a reaction to those ODs who minimize the breadth of training, sacrifice, and knowledge base that it takes to be an ophthalmologist. Just a thought. This doesn't justify the attitude, but it's another potential explanation.

As for the general surgery comment, I really don't feel insecure around general surgeons. In fact, I have an agreement with the local general surgeons here: I promise not to do any gall bladder surgeries, and they have agreed not to reattach any retinas. Don't get me wrong--I love my general surgeons. They work hard, and they do it at all hours of the day and night. It's not that I could not have been a general surgeon, it's that I chose not to. But as you know, I am still an intern. Ask me again in 4 years.
 
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