Thoughts? By allow I mean stop legislatively fighting it, if ODs stop pushing for surgical Privs.
Draw the line at surgery but allow all non surgical Dx/Tx for ODs
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Uh... no.
Ophthalmologists stand to gain nothing and lose a great deal from any expansion of ODs' scope of practice. Much of ophthos' income comes from non-surgical procedures like lasers, injections, and so on. Why would they want to cede this ground?
Ophthalmologists stand to gain nothing and lose a great deal from any expansion of ODs' scope of practice. Much of ophthos' income comes from non-surgical procedures like lasers, injections, and so on. Why would they want to cede this ground?
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I don't know what optometrists learn in school, but I'd bet that most ODs can accurately diagnose AMD, PDR, etc. Can they not diagnose those and other bread-and-butter conditions?
As I've said in other threads, the way training in eye medicine (for lack of a better phrase) is split between optomtery and ophthalmology is utterly ridiculous.
Sure, Diagnosis is not the issue. Treatment arsenal can be an issue in some states. I'm just saying;
OD=complete medical (non-surgical) eyecare??
MD=medical and surgical eyecare with a strong emphasis on surgery and OD referrals.
non-surgical with the exception of;
65125 Modification of Ocular Implant (e.g., Drilling Receptacle for Prothesis Appendage) (Seperate Procedure)
65205 Removal of Foreign Body, Externally; Conjunctival Superficial
65210 Removal of Foreign Body, External Eye; Conjunctival Embedded (Includes Concretions), Subconjunctival, or Scleral Nonperforating
65220 Removal of Foreign Body, External Eye; Corneal, without Slit Lamp
65222 Removal of Foreign Body, External Eye; Corneal, with Slit Lamp
65430 Scraping of Cornea, Diagnostic, for Smear and/or Culture
65435 Removal of Corneal Epithelium; with or without Chemocauterization (Abrasion,Curettage)
67820 Correction of Trichiasis; Epilation, by Forceps Only
68761 50 Closure of the Lacrimal Punctum; by Plug, Each (Max. 4 Units) (Used in Conjunction with A4263)
68761 51 Closure of the Lacrimal Punctum; by Plug, Each (Max. 4 Units) (Used in Conjunction with A4263)
68800 Dilation of Lacrimal Punctum, with or without Irrigation, Unilateral or Bilateral
68820 Probing of Nasolacrimal Duct, with or without Irrigation, Unilateral or Bilateral
68830 Probing of Nasolacrimal Duct, with or without Irrigation, Unilateral or Bilateral ;with Insertion of Tube or Stent
This is what most states allow now.
Thoughts??
OD=complete medical (non-surgical) eyecare??
MD=medical and surgical eyecare with a strong emphasis on surgery and OD referrals.
non-surgical with the exception of;
65125 Modification of Ocular Implant (e.g., Drilling Receptacle for Prothesis Appendage) (Seperate Procedure)
65205 Removal of Foreign Body, Externally; Conjunctival Superficial
65210 Removal of Foreign Body, External Eye; Conjunctival Embedded (Includes Concretions), Subconjunctival, or Scleral Nonperforating
65220 Removal of Foreign Body, External Eye; Corneal, without Slit Lamp
65222 Removal of Foreign Body, External Eye; Corneal, with Slit Lamp
65430 Scraping of Cornea, Diagnostic, for Smear and/or Culture
65435 Removal of Corneal Epithelium; with or without Chemocauterization (Abrasion,Curettage)
67820 Correction of Trichiasis; Epilation, by Forceps Only
68761 50 Closure of the Lacrimal Punctum; by Plug, Each (Max. 4 Units) (Used in Conjunction with A4263)
68761 51 Closure of the Lacrimal Punctum; by Plug, Each (Max. 4 Units) (Used in Conjunction with A4263)
68800 Dilation of Lacrimal Punctum, with or without Irrigation, Unilateral or Bilateral
68820 Probing of Nasolacrimal Duct, with or without Irrigation, Unilateral or Bilateral
68830 Probing of Nasolacrimal Duct, with or without Irrigation, Unilateral or Bilateral ;with Insertion of Tube or Stent
This is what most states allow now.
Thoughts??
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Well you would be very surprised then to know that's often not at all true.
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If you could please clarify, what does this have to do with the premise of the thread?
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What are people's thoughts on a separate, surgical pathway for ODs that desire surgical rights? Similar to maxillofacial surgery training for dentists which incorporates an MD into training. There could be programs that provide the additional training needed for an MD along with what is essentially an ophthalmology residency for surgical training.
It seems that it is a minority of ODs that actually want to do surgery. Giving these ODs no practical options for this will only encourage continued attempts at legislation to forcefully acquire surgical privileges. The demand for procedural eye care is only going to grow in the coming decades and I think MDs need to take control of the training process.
It seems that it is a minority of ODs that actually want to do surgery. Giving these ODs no practical options for this will only encourage continued attempts at legislation to forcefully acquire surgical privileges. The demand for procedural eye care is only going to grow in the coming decades and I think MDs need to take control of the training process.
No.
They do have an option: go back to medical school and then get into residency. I know of plenty of ODs who have done it. If you want to be a physician and surgeon, go to medical school. Period.
OMFS is its own specialty, it's not dentists wanting to fill a niche already serviced by another medical specialty. And you actually don't need an MD to be one. There are plenty of residencies that don't get you an MD along with it.
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Setting aside the economic considerations for ophthalmologists themselves, this would be disastrous for patients. How many eye conditions can be treated in isolation without considering systemic pathology? Diabetic retinopathy, hypertensive retinopathy, most uveitis cases... etc. Treating and diagnosing medical eye conditions in isolation without considering the whole medical picture of the patient would do patients a huge disservice. Also, prescribing drugs requires an extensive knowledge of drug mechanisms, interactions and side effects. This understanding requires knowing how eye drugs affect other organs that optometrists know nothing about. How do you suggest an optometrist, who has no medical training, go about treating these diseases? Although many eye diseases can be managed medically, most are also managed with a surgical component. Being treated by someone who has no understanding of the surgery will likely lead to stilted and narrow decision making. Most optometrists did not have the qualifications to go to medical school. They don't have medical training, and their judgment in choosing treatments would suffer for it. You'd be creating a shortcut for little gain..
We should however encourage optometrists to do more screenings, like for Retinopathy of Prematurity or early signs of ARMD so that people who otherwise would not see an eye doctor will get the care they need before more serious symptoms arise.
We should however encourage optometrists to do more screenings, like for Retinopathy of Prematurity or early signs of ARMD so that people who otherwise would not see an eye doctor will get the care they need before more serious symptoms arise.
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It does surprise me that they don't learn these during the four years of optometry school.
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It's more likely because an optometrist is trained to be an expert at refraction/ optics.
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In theory, they're supposed to learn a bit more than that.
For example: http://optometry.berkeley.edu/students/curriculum-od-program
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It doesn't matter what they learn in a classroom. On top of our 2 years of coursework, we then do two years of rotations, and then an intern year. We then do 3 years of seeing patients with significant pathology in their eye often related to systemic disease. We see PVR, Vit heme, significant trauma related conditions, etc...
Optoms don't see as much of this, unless they do a particular residency/internship, which is an option. They have limited experience with trauma since those people usually go to ED. I am not sure how much experience they get with PVD and RRD either. People are often seeing them for refractive error, presbyopia, contact lens fittings... Part of our training is exposure to a pattern or exam finding over and over. It helps you recognize things and learn to discern between things that can look similar, particularly in the retina exam.
Though this is not true of the majority of optoms, for the few, expanding the scope of optometry plays into hubris and overconfidence. It's very important for optoms to know when to refer. And if you start trying to act like they can take care of everything, then they say hey I can do this... Hence the endless referral for end stage glaucoma after 15 years of non surgical treatment, and so on...
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I do not agree with allowing optometrists to do anything except surgery. Ophthalmology residents learn more than surgery.
I wish that ophthalmologists are allowed to practice law except not allowed to argue a case in court. I do not want the hassle of going to law school and taking the bar exam but I would like to be able to practice certain kinds of law. I would love to be able to write wills and trusts, do estate planning for others, practice elder law, etc.
I wish that ophthalmologists are allowed to practice law except not allowed to argue a case in court. I do not want the hassle of going to law school and taking the bar exam but I would like to be able to practice certain kinds of law. I would love to be able to write wills and trusts, do estate planning for others, practice elder law, etc.
I can see where y'all are coming from. There are some bad ODs out there for sure. Especially retail where skills atrophy. I guess I'm coming at the issue with my own personal experience of medically treating a vast array of ocular conditions and referring/testing when systemic etiology is suspected. We all refer, no one wants to get sued. I would say ODs are typically more quick to refer than to hold the patient. ODs are generally under-confident in my view. Thanks for the discussion
Not so much anymore. Experts at refraction and optics are a dying breed. With all of the new technologies for refraction, OD schools have seen the writing on the wall and have been shifting away from emphasizing these skills for 20+ years.
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We haven't had one of "these threads" in a while. Lol
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The curriculum appears to have more emphasis on theory and refractive science. The clinical training appears less emphasized than the optics and refractive sceince- I mean one class devoted to anterior segment?
Just to note, I am not putting down the optometry curriculum or to bash their training, but to emphasize that there is a lot that goes on to determine if a patient needs something invasive and procedural, you need to know what you're treating and what exactly to do if something goes wrong. An office procedure isn't hard once you've done enough, it's doing it for the right reasons. There's really no way around it, but it takes a residency or similar clinical training to gain this kind of experience. Even general ophthalmologists are not 100% confident in all procedures.
I do agree that most optometrists will thankfully refer pretty quickly when they are out of their comfort zone (sometimes a little too quickly - especially in the emergency room for a "retinal detachment") but as other posters have said, expanding scope of practice without the proper training can lead to hubris, overconfidence, and delay of proper treatment.
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Agree with multiple comments here. Being in a medical internship + residency teaches you how to think as a systemic diagnostician. Seeing pathology in the eye and the rest of the body, taking call (having the autonomy when it's just you with limited resources), and getting first-hand experience with peri-operative care definitely bolsters the understanding and allows us to produce elaborate differentials that we can later refine. It is also enlightening in terms of realizing when you're in over your head and need help, as mentioned in the video and comments above.
The above is why I am more inclined to promote against optometry having the ability to do minor operations or procedures. The problem is that the optometric society has superior lobbying power, and they graduate more students and more quickly than ophthalmology. Becoming more involved with legislation, graduating more ophthalmologists, and incentivizing these graduates to head towards more rural areas would be helpful. In the end, though, both fields are kindred in the main goal to restore and/or preserve vision and quality of life.
The above is why I am more inclined to promote against optometry having the ability to do minor operations or procedures. The problem is that the optometric society has superior lobbying power, and they graduate more students and more quickly than ophthalmology. Becoming more involved with legislation, graduating more ophthalmologists, and incentivizing these graduates to head towards more rural areas would be helpful. In the end, though, both fields are kindred in the main goal to restore and/or preserve vision and quality of life.
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I don't believe that guy for a minute, that some OD decided "to scrape the cornea with a needle" presumably behind slit lamp, and not recognize that the FB was intraocular? GTFOOH, sorry that is not believable at all. Stories like that and other childish comments put forth by residents literally destroys your credibility IMO. I am loath to trust you at all, and am left with no other option but to encourage ODs to pursue scope of practice goals entirely through legislative channels.
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Given the complaints I hear about falling salaries and increasing competition, this seems an unwise move unless y'all like doing 4 cataracts/month each.
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Hard to believe but not impossible. I can't speculate or comment since I was not there assessing the patient and their history.
Agree in certain circumstances, but it would also provide rural patients with access to surgery/procedures where poor surgical/procedural access is the big argument in expanding optometric scope of practice. Incentivizing ophthalmologists to go out in the rural areas and not the urban is how it would need to be done which would be difficult but not impossible.
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Not hard to believe at all. A missed IOFB is a very definite possibility in certain types of trauma and relatively common cause of malpractice lawsuits. A small, self sealing corneal laceration with some metallic residue at the entry site could be mistaken for only a corneal process if you aren't trained to properly evaluate the rest of the eye and know when to obtain imaging (b scan and/or CT) as needed to detect a possible IOFB. This is exactly the type of situation where optometric training is deficient since there is so little pathology, especially trauma, that is seen during training. The fact that you aren't aware that in the correct setting a possible missed IOFB is always a concern when dealing with ocular trauma is illustrative of this point.
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we are all well aware of self sealing corneal entry points, so spare us your assessment of "the facts". I never said any such thing about IOFB, and you are projecting your own bias into the discussion. It's almost laughable to find you thinking that ODs aren't aware of such things, as if it was some sophisticated concept. When you say things like that, I say to myself "hmmmm, what else is this guy lying about?".
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I think you'll have a harder time doing that then even getting us family docs out in the boonies. You're asking surgically minded physicians to go somewhere that would almost guarantee a lower-than-desired surgical volume.
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I'm sure the majority of optoms would refer out to ophthalmologists when they got out of their comfort zone. The problem is that laws aren't really made for the majority, they are made to protect patients from a small percentage of people who would practice outside of their scope. It only takes a few bad eggs to hurt thousands of patients. I think I have said this before, but the story would be different if they had pathology/surgical fellowships for optoms. My guess is that these would be extremely competitive, which would mimic the competition med students experience when applying to Ophtho residencies (remember it is an extremely difficult match for us). I think the main problem with the argument to expand optom practice is that Ophtho is actually one of the more saturated markets. Of course there will always be rural areas without access to specialty care, but I'm not convinced that optoms are any more likely to choose these practice locations. We currently produce enough ophthalmologists if we were to distribute them evenly. Most optom schools are located in cities, so this argument doesn't really hold water. I think the main goal we should have is to protect our patients not to line our wallets...but that is just me.
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They do have pathology-ish residencies (not fellowships since those imply a residency first), usually through the VA which we must all admit does have some pretty crazy pathology.
I think the rest of your post has merit, and even most ODs would agree - the trick as always as where to draw that line.
