Expanded Scope of Practice in KY (close to becoming a reality)

[eyestrain]

For the bill "not being about surgery, it sure talks a lot about surgery.". The authors cannot be trusted because most of the things listed are so far beyond current optometric teaching today. Therefore, people have every right to question what will take place in training the newly legislated "surgeons".

for the newly legislated "surgeons", the oath MDs follow is first do no harm. Therefore, I realize the guy on the plane is not calling for me when he asks for a doctor. And I guarantee he us not calling for an optometrist. Get over yourself and your "doctoral" degree. I accept I do not know everything about medicine after my 10 years of medical training - why can't you do the same after 4 years of optometric training?

Nice quotation marks, troll.

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[200UL]

Nice quotation marks, troll.

Your profession needs to step up to the plate. It is time to show equivalent training if you are interested. Your profession has yet to prove interest in this (it can be done, however. Unfortunately, it will take actual work and not simply $.)...

The wise politicians in the great state of Kentucky have declared that you are "surgeons" now. You can prescribe any medication (except for general anesthesia and those dangerous highly addictive narcotics). Eyestrain - it time to start acting like a doctor and deal with criticism. My credentials are scrutinized on a daily basis by patients, hospitals, and insurance companies. Until you do so, those of you who perform the "laser lens extraction" and like surgeries described in the bill will be perceived as frauds.

Feel free to critique my training as well. I feel very comfortable standing behind it.

 

[eyestrain]

Your profession needs to step up to the plate. It is time to show equivalent training if you are interested. Your profession has yet to prove interest in this (it can be done, however. Unfortunately, it will take actual work and not simply $.)...

The wise politicians in the great state of Kentucky have declared that you are "surgeons" now. You can prescribe any medication (except for general anesthesia and those dangerous highly addictive narcotics). Eyestrain - it time to start acting like a doctor and deal with criticism. My credentials are scrutinized on a daily basis by patients, hospitals, and insurance companies. Until you do so, those of you who perform the "laser lens extraction" and like surgeries described in the bill will be perceived as frauds.

Feel free to critique my training as well. I feel very comfortable standing behind it.

Have at it, boss, I don't debate trolls. I suspected you were from the start and you only proved it with the quotation mark bull****.

 

[200UL]

You do not only have debate me - you have to debate your profession. KY lawmakers have created a new type of eye "surgeon". I am wondering how the training will be implemented - aren't you?

This is very relevant to me as the older style of eye surgeon who works with optometrists who were not trained as surgeons. I work with optometrists every day and I feel I am lucky to have their expertise. However, If any of them shows up one day and asks to do " laser lens extraction" or any of the other bogus procedures listed in the bill, I will ask them to describe their training.

Develop the training programs that involve humans and share it with the world - be proud of it. Again i am proud of my training. Paying off politicians was the easy part....

 

[eyestrain]

You do not only have debate me - you have to debate your profession. KY lawmakers have created a new type of eye "surgeon". I am wondering how the training will be implemented - aren't you?

This is very relevant to me as the older style of eye surgeon who works with optometrists who were not trained as surgeons. I work with optometrists every day and I feel I am lucky to have their expertise. However, If any of them shows up one day and asks to do " laser lens extraction" or any of the other bogus procedures listed in the bill, I will ask them to describe their training.

Develop the training programs that involve humans and share it with the world - be proud of it. Again i am proud of my training. Paying off politicians was the easy part....

You should go tell them to their face that they're only "doctors".

 

[Optogal]

Feel free to critique my training as well. I feel very comfortable standing behind it.

Is this what this is about? No one is here to put down ophthalmology, but it seems some folks feel the need to put down optometry.

Anyways - the law passed. That's how the game is played. Really, there is no point griping to optometrists. ODs long ago learned that to expand scope, you don't even need to bother talking to the OMDs. Just go straight to the lawmakers. As OMDs know too well, the stroke of a pen can turn ODs into OMDs, and there's nothing anyone can do about it.

That's the reality. If you don't like it, get elected and change the way the law is done.

 

[JaggerPlate]

ODs long ago learned that to expand scope, you don't even need to bother talking to the OMDs. Just go straight to the lawmakers. As OMDs know too well, the stroke of a pen can turn ODs into OMDs, and there's nothing anyone can do about it.

So this makes it okay and safe for unsuspecting patients? To give someone the privileges of a DO/MD with the stroke of a pen?

This entire situation has really changed my opinion of Optometrists. It's honestly disappointing, and it's unfortunate to see individuals with a doctorate level degree and valuable skill set sink into the dirty politics used by unqualified midlevel groups like NPs, CRNAs, and midwives to make themselves feel more like physicians.

I'll definitely express these sentiments to my colleagues in the same light as I do NPs, CRNAs, DCs, midwives, etc whenever these topics are brought up.

 

[Shnurek]

So this makes it okay and safe for unsuspecting patients? To give someone the privileges of a DO/MD with the stroke of a pen?

This entire situation has really changed my opinion of Optometrists. It's honestly disappointing, and it's unfortunate to see individuals with a doctorate level degree and valuable skill set sink into the dirty politics used by unqualified midlevel groups like NPs, CRNAs, and midwives to make themselves feel more like physicians.

I'll definitely express these sentiments to my colleagues in the same light as I do NPs, CRNAs, DCs, midwives, etc whenever these topics are brought up.

Maybe if you didn't perceive us in such an inferior way as we are all "doctors" then we would not have internal frustration and fight for expansion.

Just like if you anger a cop he will put you down for as many violations as he/she can think of. But if you are polite about it then they might even let you walk.

Anger is one of the most primitive emotions so your "doctoral" level of study just means you can memorize well but your executive functions still lack.

Arrogance -> Provocation -> Legislative Action

 

[JaggerPlate]

JaggerPlate,

Just wondering, do you go to a real medical school (that awards M.D.s) or the other one that people go to when they cannot get into a real medical school

I go to the one "for people who can't get into a real medical school."

Why do you ask?

 

[Jay12]

JaggerPlate,

Just wondering, do you go to a real medical school (that awards M.D.s) or the other one that people go to when they cannot get into a real medical school

Come on....don't you think that was a little uncalled for?

The great thing about a site like this, in my humble opinion, is participating in open discussions about the topics affecting our professions. Even though we may not all agree on all of the changes taking place, one must try to act as a professional, especially when they are representing many members (students and doctors) of their profession.


Hahaha.....probably sounds really corny

 

[KHE]

I go to the one "for people who can't get into a real medical school."

Why do you ask?

Maybe we should ask SDN to start a forum where all the optometrists, dentists, podiatrists, osteopaths, psychologists, et al can get together. Maybe we'll even include the vets. We can call it the "not quite real doctors forum" or "not ready for prime time doctors forum" or something like that.

Then we can all get together and bitch about which one is even MORE of a "not a real doctor" than the other and we can discuss who should be allowed to raise their hand when someone asks "is there a doctor in the house" in a crowded theater or on an airplane and why. Then we can talk about how PhDs are the "REAL" doctors and how much we all "respect" each other.

 

[orbitsurgMD]

. . . That's how the game is played.

You said it. For less than the cost of two optometric degrees.

Really, there is no point griping to optometrists. ODs long ago learned that to expand scope, you don't even need to bother talking to the OMDs. Just go straight to the lawmakers. As OMDs know too well, the stroke of a pen can turn ODs into OMDs, and there's nothing anyone can do about it.

Well, no, it is only a law. It can be repealed.

If you think the only difference between an O.D. and an ophthalmologist is a lawmaker's signature, then I guess we won't be seeing any real training programs established soon in the Bluegrass State. After all, what is the point? Training to do surgery wouldn't appear to have anything to do with being "qualified."

That's the reality. If you don't like it, get elected and change the way the law is done.

Why run for office? The Kentucky ODs just proved you can rent the legislators by the vote, much better value for the political dollar.

 

[Optogal]

Well, no, it is only a law. It can be repealed.

It can be repealed. But it can also not be repealed. If the law designates OD = OMD, then that becomes the legal reality.

If you think the only difference between an O.D. and an ophthalmologist is a lawmaker's signature,

I never suggested that anywhere (in a clinical respect, which I believe you are referring to) but I did state that legally, it can be done. And legally, it can. I'm not saying I agree with it, but if legally these things can't be done, then why all the fuss from OMDs about the Kentucky legislation?

You do recognize as fact, that with the stroke of a pen, ODs became "Optometric Physicians"? Whether you yourself recognize the term is irrelevant, it is a matter of law in certain states.

Anyways - I'm not pro-OD or anti-OMD or whatever, but complaining about the reality to optometrists isn't going to get you anywhere. You have to effect laws to make changes. That's how things work.

Why run for office? The Kentucky ODs just proved you can rent the legislators by the vote, much better value for the political dollar.

And OMDs can do the same if they are willing to.

 

[Meibomian SxN]

It can be repealed. But it can also not be repealed. If the law designates OD = OMD, then that becomes the legal reality.......

I wonder what happened to their friend Rand Paul in KY....seems like he's busy sipping on 'tea' $$$ and becoming more learned in civil rights equality

 

[Optogal]

I'll just make a remark that I've had a sit-down with a prominent U.S. optometric academic (OD/PhD at one of the top US medical university hospitals) who assisted in a visiting capacity with scope optometric scope recognition in a 2nd/3rd world country. He's in his 60s/70s and has witnessed first hand, the evolution of scope in the U.S.

Chatting strategy with him, I asked him in passing about organized ophthalmology and how to address/meet with them. He just basically said ignore them, we don't need to talk to them, there's no use talking to them, they aren't worth talking to, we just have to talk to the legislators. Within 6 months he had a bill tabled for legislation. This was after 25+ years of getting nowhere, by trying to get optometric scope through ophthalmology.

So - it's about laws. I'm not sure why you disagree with this, if in fact you do.

 

[JaggerPlate]

I ask because I find your posts offensive toward optometrists. You do realize that D.O.'s also fought many battles with M.D.s with regard to the recognition and the scope of the practice, don't you?

I thought that you would be more tactful and sensitive, which I don't observe in your posts.

Try not to compare O.D.'s with chiropractors, the same comparison was made to D.O.s by M.D.s years ago in order to denigrate the profession.

Of course I know this, in fact, I've brought it up several times in my arguments. However, the crucial difference between the DO battle and the OD battle is one of my biggest issues with expansion. When DOs decided that they wanted to leave pure manipulation behind and embrace evidence based medicine, they didn't achieve this by stuffing the pockets of unethical politicians. Look at the evolution of DOs from around the 1920s up until the 1960s - conforming to the MD model of education, implicating appropriate rotations, creating post graduate medical education, licensing exams on par with the US MD model, meeting (not bribing) with government officials to achieve goals like being recognized as physicians in the armed forces.

The DOs saw where they wanted to go and how they needed to evolve, and they made painstaking strides over DECADES to get there. The result were physicians that are so on par with the US MD that they are now eligible to practice unrestricted medicine, sit for the USMLE (the MD steps) and complete ACGME (MD) residencies, and are recognized legally as full fledged physicians (sorry, I don't think I'll make it to the 'who's a doc' thread). This is evolution and not only did it prove parity, but it also was the best option for patient safety and transparency.

I said time and time again during the OD expansion discussion that I have absolutely no problem with evolution - evolution is fine, necessary, and a reality. However, this scope expansion isn't evolution via increased training, meeting a level of acceptable standards, etc, it's paying and bribing for the rights to act like a surgeon.

Furthermore, these ad hominem attacks truthfully demonstrate that there really isn't much of an argument to be had here and do nothing to reinstate my faith in the idea that this expansion was to practice to the full extent of a license or to increase patient care. It, again, reinforces the idea that this expansion was done to fill some type of insecurity and take what a group FELT they were ENTITLED to. Additionally, like I said before, this type of mentality is something normally reserved for unqualified midlevels who know they aren't on par with the accepted norm (DO/MD) so they take what they want by force and back room politics. This attitude is disappointing from a group of respected, doctoral level health care providers.

So, in this sense, I don't feel like you've given me much cause NOT to compare ODs to some of these other health care providers (as outlined above), nor do I think their plight is similar to that of DOs. Trust me, the irony would not be lost on me if it did exist.

 

[Shnurek]

Thanks Yushin.

 

[orbitsurgMD]

I wonder what happened to their friend Rand Paul in KY....seems like he's busy sipping on 'tea' $$$ and becoming more learned in civil rights equality

I speak only for myself, but that apple didn't fall far from the tree.
As an ophthalmologist, I find Rand Paul to be embarrassing. The idea about starting his own certifying board because he was peeved about the grandfathering of other older certified ophthalmologists by the ABO is just crackpot behavior (I am post-grandfathering and re-certified, FWIW.)

As an aside, if Kentucky doesn't want to appear like a total backwater state, their esteemed legislators might require some formal training program for optometrists who want to do surgery in their state. Requiring a post-doctoral two or three-year long M.Sc. in ophthalmic surgery at a university teaching hospital with intensive first surgeon case experience might be a credible start, similar to what dentists doing specialized dental surgery do now.

The lumps and bumps surgical license is troubling. I really do believe some optometrists who don't know what they don't know really will get in over their heads.

 

[Princeod2583]

Of course I know this, in fact, I've brought it up several times in my arguments. However, the crucial difference between the DO battle and the OD battle is one of my biggest issues with expansion. When DOs decided that they wanted to leave pure manipulation behind and embrace evidence based medicine, they didn't achieve this by stuffing the pockets of unethical politicians. Look at the evolution of DOs from around the 1920s up until the 1960s - conforming to the MD model of education, implicating appropriate rotations, creating post graduate medical education, licensing exams on par with the US MD model, meeting (not bribing) with government officials to achieve goals like being recognized as physicians in the armed forces.

The DOs saw where they wanted to go and how they needed to evolve, and they made painstaking strides over DECADES to get there. The result were physicians that are so on par with the US MD that they are now eligible to practice unrestricted medicine, sit for the USMLE (the MD steps) and complete ACGME (MD) residencies, and are recognized legally as full fledged physicians (sorry, I don't think I'll make it to the 'who's a doc' thread). This is evolution and not only did it prove parity, but it also was the best option for patient safety and transparency.

I said time and time again during the OD expansion discussion that I have absolutely no problem with evolution - evolution is fine, necessary, and a reality. However, this scope expansion isn't evolution via increased training, meeting a level of acceptable standards, etc, it's paying and bribing for the rights to act like a surgeon.

Furthermore, these ad hominem attacks truthfully demonstrate that there really isn't much of an argument to be had here and do nothing to reinstate my faith in the idea that this expansion was to practice to the full extent of a license or to increase patient care. It, again, reinforces the idea that this expansion was done to fill some type of insecurity and take what a group FELT they were ENTITLED to. Additionally, like I said before, this type of mentality is something normally reserved for unqualified midlevels who know they aren't on par with the accepted norm (DO/MD) so they take what they want by force and back room politics. This attitude is disappointing from a group of respected, doctoral level health care providers.

So, in this sense, I don't feel like you've given me much cause NOT to compare ODs to some of these other health care providers (as outlined above), nor do I think their plight is similar to that of DOs. Trust me, the irony would not be lost on me if it did exist.

Do you really understand how expansion of rights works? Specifically pertaining to optometry? Do you realize that in order to expand scope of practice that we must first secure those rights, and ensure that in fact we would be able to LEGALLY perform those services before enacting proper training? No optometrist will go out tomorrow and start performing laser services just because it passed into law. The fact that optometry is now establishing board certification enables Kentucky ODs to implement a strategy for training OD's in regards to "surgical" techniques. If the board certification model is enacted, it requires a 1 year residency, among other skills to be performed, before the prospective OD is awarded with board certification. This is a model in its infancy and it will be refined as time goes on. But there is no way you would start training these techniques to OD's if you did not have the legal right to do so. Hence pass the law first, train accordingly second......So why can't OD's enact a surgical training model through board certification, with a specific number of practice cases, training with rigorous requirements, and proving that these techniques can be learned and perfected just like any other doctor?

 

[JaggerPlate]

Do you really understand how expansion of rights works? Specifically pertaining to optometry? Do you realize that in order to expand scope of practice that we must first secure those rights, and ensure that in fact we would be able to LEGALLY perform those services before enacting proper training?

Yes, I understand this. However, I also understand that it's not illegal to outline a concrete plan for training expansion to coincide with the bill either officially or unofficially. Where's the plan? Where's the statement of intent? Where is there anything about the training that correlates with the expansion whatsoever?

No optometrist will go out tomorrow and start performing laser services just because it passed into law.

Answer me this ... legally, all ethical, moral, and assumptive reasoning aside, COULD they. Because it's now legal, could an optometrist go out and buy a laser today and perform an operation tomorrow with no legal recourse? I'm not asking you if they would, or if they should, I am asking you if LEGALLY they can. Because as I see it, the bill provided this privilege, but did not place any specific limits, thus far, on the training that would be required beforehand.

If I'm wrong, please correct me, because frankly I would be happy to hear otherwise. Legally - not wouldn't, unlikely, etc, ... can they.

The fact that optometry is now establishing board certification enables Kentucky ODs to implement a strategy for training OD's in regards to "surgical" techniques.

Can you send me a link to the surgical board certification aspect of the OD board? I'd like to see what type of standards are in place.

If the board certification model is enacted, it requires a 1 year residency, among other skills to be performed, before the prospective OD is awarded with board certification.

If the board certification model is enacted? Why wouldn't it be enacted? Two sentences ago, you told me it was a fact? Now it's an 'if; then' statement? Is this just another assumption on the part of the OD community?

A 1 year residency? Again, can I see a link to this please? Is it a surgical residency? Who designed it? How many patients are seen? What programs are affiliated with it? What 'other skills' are taught in the residency? Why is an Ophthalmology residency an internship + 3 years surgical but this OD residency is only a year and covers eye surgery AND 'other skills.'

This is a model in its infancy and it will be refined as time goes on. But there is no way you would start training these techniques to OD's if you did not have the legal right to do so.

Agreed, but why can't there be some sort of formal statement as to what type of training will exist, how it will be regulated, etc. If I've missed this outline, PLEASE fill me in, because it will honestly quell a lot of my concerns. However, all I'm hearing time and time again are a bunch of completely unfounded guesses, assumptions, and anecdotes.

Hence pass the law first, train accordingly second......So why can't OD's enact a surgical training model through board certification, with a specific number of practice cases, training with rigorous requirements, and proving that these techniques can be learned and perfected just like any other doctor?

If they can, then I certainly would feel much better about this expansion. Would I personally see/recommend an eye surgeon who hasn't attended medical school and completed a surgical residency? No, but this isn't my decision nor is it my place to judge. If you've proven safe, reliable, surgical efficacy, then great. I wish it wasn't achieved through this type of politics, but that my have been inevitable and a reality of the country we live in.

However, what seems to be the reality here is that the bill is passed, and there is absolutely no formal plan or outline as to how this training or certification will occur. I keep hear you throwing around things like board certification, training models, a specific number of cases, techniques, etc. Do you have any idea of the amount of money, highly trained individuals, and manpower it takes to make this happen? Frankly, I've seen countless medical residency programs (from the DO world) close down because all these requirements and goals were in place, but the amount of time, money, and individuals it took to run these programs simply wasn't there.

Where are you going to find a hospital/clinic with this steady patient stream? Who is going to teach these procedures? Who's going to sit on the board? Hell, who's going to pay for this???

I know there are people much smarter than me in charge of organizing this, but assuming that this sort of training and certification will just fall into place AFTER the law has been enacted AND assuming that it's just something you can throw together and start pumping people through just isn't realistic.

 

[Meibomian SxN]

Yes, I understand this. However, I also understand that it's not illegal to outline a concrete plan for training expansion to coincide with the bill either officially or unofficially. Where's the plan? Where's the statement of intent? Where is there anything about the training that correlates with the expansion whatsoever?

Nah, it makes more sense to give someone an unrestricted DO license and then teach them a specialty thereafter.

 

[orbitsurgMD]

Nah, it makes more sense to give someone an unrestricted DO license and then teach them a specialty thereafter.

Well, good luck getting paid by any insurance companies without being board-certified. For that matter, you won't be able to work at any hospital or surgery center either, they don't let someone in just because they have an "unrestricted license;" that is a necessary but not sufficient prerequisite for appointment.

Let's see if CMS signs on to this whole scheme. Insurance companies may not be willing to pay non-ophthalmologists for procedures heretofore done only by surgeons. You won't be able to dodge disclosing your NPI number on your 1500s.

 

[geronamo26]

You can stop now, Orbitsurg. Stop lecturing, stop complaining, stop whinning. Its over and there is nothing you can do but accept it.

 

[orbitsurgMD]

You can stop now, Orbitsurg. Stop lecturing, stop complaining, stop whinning. Its over and there is nothing you can do but accept it.

Not lecturing. Not whining. Not over, either.

 

[200UL]

I agree - it will be interesting to watch CMS / insurance companies react to the bill. Billing surgical codes by non-surgeons seems strange to me?

I do agree that this bill has forced me to question the integrity of optometry as a profession. "250,000 procedures - no complications" It is scary if they actually believe this - No MD would quote such a number for any procedure/any treatment.

Finally, I love watching the news interviews of optometry describing their skills/the bill. 90% of the time, the statements made contradict the bill (it makes me wonder if the spokespeople understand the bill - alternatively they simply feel comfortable lying). Dr. Ben Gaddie seems like a top notch "surgeon" by looks and style, but in his mind an anterior chamber paracentesis does not involve entering the eye (I am sorry - he looks ignorant to the educated observer - it calls into question everything he says about his skill). I also would love to see him suture.

I also like how Gentle Ben Gaddie rips on nurses for suturing under the direction of surgeons. I personally would prefer having a nurse or PA well versed in surgery / mechanics in the operating room perform a procedure on me - they actually have a clue what is involved working in a hospital / medical environment. Nurses and PAs actually train on humans - still the surgeon is responsible for all actions. I know current optometry schools offer zero surgical training with humans, but do they actually get their newly designated "surgeons" into an actual operating room - this might provide a nice introduction.

 

[IndianaOD]

I'm not hating at all - just being realistic. I'm aware of our limited education and I believe we shouldn't be trying to push for practice rights that's beyond our training. If you want to become an eye surgeon, great, there is medical school for a reason...but then again, you mentioned in one of the other threads that you can't invest another $250,000 + interest at this point in your life to get a medical degree. So I guess this is your solution to becoming an eye surgeon - through the back door?

I think the profession has lots to fix and pushing our practice boundaries into ophthalmologists territory shouldn't even be a priority. I'm happy with the scope of our practice at this point and I'll be happier for the profession when the AOA stops permitting new schools to open.

Wow, I hope we don't have too many OD students out there like you. Optometry should be allowed to regulate itself as does medicine. The procedures granted in bills like this are not complicated at all.

Any OD can focus on the back of the IOL (YAG), if you can use a gonio lens (which you should be on all glaucoma patients) and focus on the pigmented trabecular meshwork you can do SLT. Focus on the superior iris and you can do a PI.

OD students can perform these technical tasks before the end of the second year. We already refer for these procedure so we know when they are needed. This isn't surgically repairing a brain aneurysm.

I think you forget that ODs spend their education focusing on the eye and adnexa. 4 years or 5 with residency. Ophthalmologists go to medical school but almost no time is spent on the eye. All their day to day knowledge is from the residency. I have several very good friends from my pre-med undergrad that have confirmed this after getting their MDs.

Don't start the inferiority complex already. I out achieved all the students in undergrad that eventually got MDs

This whole debate was never about patient safety. It is about money. The MDs will do anything to retain their monopoly (and associated money) over all medical care. MDs used to shout that ODs would kill people with tropicamide. Interesting to note it is much safer than peanut butter. You don't seeing them piss an moan nearly as much about dentists because they compete much less over the almighty dollar even though some dentists do quite complex surgery.

 

[al074755]

Governor Steve Beshear's Communications Office

Statement from Gov. Beshear on Senate Bill 110

Press Release Date: Thursday, February 24, 2011
Contact Information: Kerri Richardson
Jill Midkiff
502-564-2611


FRANKFORT, Ky. — “Access to quality health care is a critical issue for families across the Commonwealth. After careful consideration, along with meetings with many interested parties, today I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care. A review by the Department of Medicaid finds that this legislation has little or no fiscal impact on the Medicaid budget. This bill passed overwhelmingly in both legislative chambers (81-14 in the House and 33-3 in the Senate), showing broad bi-partisan support. And finally, in order to ensure the highest degree of oversight, I will be meeting with the Board of Optometric Examiners to make sure that providers of these services undergo extensive training. I believe this new law will mean more Kentuckians can get the eye care they need.”

http://migration.kentucky.gov/Newsroom/governor/20110224sb110.htm

 

[IndianaOD]

Oh, FYI.

For all those MDs and ophthalmologists who want to keep their very generous incomes you could step up to the plate and help us confront these unnecessary new OD schools that are popping up all over the place at private medical schools.

We already have oversupply and if you feel the pressure now just wait until new ODs can't make a decent income. They will have nothing to do but pursue better paying procedures.

 

[orbitsurgMD]

Oh, FYI.

For all those MDs and ophthalmologists who want to keep their very generous incomes you could step up to the plate and help us confront these unnecessary new OD schools that are popping up all over the place at private medical schools.

We already have oversupply and if you feel the pressure now just wait until new ODs can't make a decent income. They will have nothing to do but pursue better paying procedures.

They won't be "better paying" for long. You really are describing the race to the bottom phenomenon. Oh, and when you start doing surgery, you will become intimately familiar with the inclusive care period attached to all surgical procedures. Forget about modifiers for "unrelated" care within the postoperative period of another procedure, too; Medicare and other carriers routinely ignore those. You will be working for free.

Why would any M.D. have any influence on how many optometrists are graduated? That would seem to be an optometric regulatory issue.

And don't crow too much about how you plan to open up competition for surgery. Idle ophthalmologists make expert witnesses.

 

[VA Hopeful Dr]

This whole debate was never about patient safety. It is about money. The MDs will do anything to retain their monopoly (and associated money) over all medical care. MDs used to shout that ODs would kill people with tropicamide. Interesting to note it is much safer than peanut butter. You don't seeing them piss an moan nearly as much about dentists because they compete much less over the almighty dollar even though some dentists do quite complex surgery.

Really? And what money am I, a family doctor, getting out of keeping ODs out of certain procedures?

Oh, FYI.

For all those MDs and ophthalmologists who want to keep their very generous incomes you could step up to the plate and help us confront these unnecessary new OD schools that are popping up all over the place at private medical schools.

We already have oversupply and if you feel the pressure now just wait until new ODs can't make a decent income. They will have nothing to do but pursue better paying procedures.

I'm actually game for that. What can I, as an MD, do to help with OD oversupply?

 

[VA Hopeful Dr]

Governor Steve Beshear's Communications Office

Statement from Gov. Beshear on Senate Bill 110

Press Release Date: Thursday, February 24, 2011
Contact Information: Kerri Richardson
Jill Midkiff
502-564-2611


FRANKFORT, Ky. — “Access to quality health care is a critical issue for families across the Commonwealth. After careful consideration, along with meetings with many interested parties, today I signed Senate Bill 110 to give Kentuckians greater access to necessary eye care. A review by the Department of Medicaid finds that this legislation has little or no fiscal impact on the Medicaid budget. This bill passed overwhelmingly in both legislative chambers (81-14 in the House and 33-3 in the Senate), showing broad bi-partisan support. And finally, in order to ensure the highest degree of oversight, I will be meeting with the Board of Optometric Examiners to make sure that providers of these services undergo extensive training. I believe this new law will mean more Kentuckians can get the eye care they need.”

http://migration.kentucky.gov/Newsroom/governor/20110224sb110.htm

See, that's all most of us non-ophtho people wanted.

 

[eyestrain]

And don't crow too much about how you plan to open up competition for surgery. Idle ophthalmologists make expert witnesses.

Oh noes. I'm terrified.

 

[orbitsurgMD]

Oh noes. I'm terrified.

Don't be; you can rent those by the hour too.

 

[Meibomian SxN]

Listen to the moot ophthalmology arguments and watch them get DISMISSED!

http://www.ket.org/cgi-bin/cheetah/watch_video.pl?nola=KKYTO+001816&altdir=&template

A discussion about the optometry bill passed by the General Assembly and sent to the governor. Guests: Ben Gaddie, O.D., president-elect of the Kentucky Optometric Association; David Cockrell, O.D., a member of the board of trustees of the American Optometric Association; Cynthia Bradford, M.D., senior secretary for advocacy with the American Academy of Ophthalmology; and Woodford VanMeter, M.D., president of the Kentucky Academy of Eye Physicians and Surgeons.

 

[200UL]

“Any OD can focus on the back of the IOL (YAG), if you can use a gonio lens (which you should be on all glaucoma patients) and focus on the pigmented trabecular meshwork you can do SLT. Focus on the superior iris and you can do a PI.”

Indiana OD – you seem like a reasonable poster, but first things first – when you start doing your YAGs – don’t focus on the IOL – make sure the energy is directed at the posterior capsule (your patient will appreciate this). This is just another example of statements that make me think your organization has no idea what you are asking for (kind of like dr gaddie not understanding that a paracentesis does not involve entry into the eye?). I don’t blame, you – I believe you need experience in actually performing the procedures to talk about them in an educated manner.

Additionally, we all know that a 10 year old could be trained the technical aspect of doing a laser PI, but what we are arguing is that the decision making is what is important. Further, I have seen multiple cases where a PI could not be used to break a case of angle closure glaucoma. What is your group’s next move here. The bill grants the ability to perform paracentesis – is this it (but then again, what if the iris starts spilling out of the eye – do you go to the OR to close the wound)? Would you go the OR for surgical iridectomy? Would you refer?

These are all practical questions for just one small aspect of the bill – perhaps simple decision trees could be developed at curriculum meeting (which I hope occurs). I know you have convinced lawmakers that complications do not occur in your hands (“250,000 procedures – no complications”). Please tell your trainees that they can occur – alternatively please share your superior techniques with those of us who have been providing surgical eye care for years.

 

[socal2014]

Listen to the moot ophthalmology arguments and watch them get DISMISSED!

http://www.ket.org/cgi-bin/cheetah/watch_video.pl?nola=KKYTO+001816&altdir=&template

A discussion about the optometry bill passed by the General Assembly and sent to the governor. Guests: Ben Gaddie, O.D., president-elect of the Kentucky Optometric Association; David Cockrell, O.D., a member of the board of trustees of the American Optometric Association; Cynthia Bradford, M.D., senior secretary for advocacy with the American Academy of Ophthalmology; and Woodford VanMeter, M.D., president of the Kentucky Academy of Eye Physicians and Surgeons.

Surprisingly, that was VERY entertaining.

 

[KHE]

Surprisingly, that was VERY entertaining.

I ask again.....are you an optometrist, in optometry school or pursuing admission to a school of optometry?

 

[bobbio]

Wow, I hope we don't have too many OD students out there like you. Optometry should be allowed to regulate itself as does medicine. The procedures granted in bills like this are not complicated at all.

Any OD can focus on the back of the IOL (YAG), if you can use a gonio lens (which you should be on all glaucoma patients) and focus on the pigmented trabecular meshwork you can do SLT. Focus on the superior iris and you can do a PI.

OD students can perform these technical tasks before the end of the second year. We already refer for these procedure so we know when they are needed. This isn't surgically repairing a brain aneurysm.

I think you forget that ODs spend their education focusing on the eye and adnexa. 4 years or 5 with residency. Ophthalmologists go to medical school but almost no time is spent on the eye. All their day to day knowledge is from the residency. I have several very good friends from my pre-med undergrad that have confirmed this after getting their MDs.

Don't start the inferiority complex already. I out achieved all the students in undergrad that eventually got MDs

This whole debate was never about patient safety. It is about money. The MDs will do anything to retain their monopoly (and associated money) over all medical care. MDs used to shout that ODs would kill people with tropicamide. Interesting to note it is much safer than peanut butter. You don't seeing them piss an moan nearly as much about dentists because they compete much less over the almighty dollar even though some dentists do quite complex surgery.

In this instance it doesn't matters whether or not you outperform your MD buddies - to me it all comes down to training. I don't question your intelligence because I'm certain you're a bright guy but my feeling is that ophthalmologists are trained specifically to be eye surgeons. Until optometry school teaches us to perform eye surgeries for a majority of our training or requires us to do a mandatory residency, I don't see a reason for us to pursue this. There are other more pressing issues with the profession.

Your comment just sheds light on one of the underlying problems associated with this issue and that is you get polarized when our training (surgical) is questioned. It seems you're misperceiving it as a personal attack on your intelligence/capacity thus the rhetoric "I out achieved all students in undergrad that eventually got MDs". I don't question an optometrists intelligence, rather, it's our training to become surgeons.

 

[IndianaOD]

In this instance it doesn't matters whether or not you outperform your MD buddies - to me it all comes down to training. I don't question your intelligence because I'm certain you're a bright guy but my feeling is that ophthalmologists are trained specifically to be eye surgeons. Until optometry school teaches us to perform eye surgeries for a majority of our training or requires us to do a mandatory residency, I don't see a reason for us to pursue this. There are other more pressing issues with the profession.

Your comment just sheds light on one of the underlying problems associated with this issue and that is you get polarized when our training (surgical) is questioned. It seems you're misperceiving it as a personal attack on your intelligence/capacity thus the rhetoric "I out achieved all students in undergrad that eventually got MDs". I don't question an optometrists intelligence, rather, it's our training to become surgeons.

Nobody is saying optometrists that haven't been trained on the procedures is going to do them. Of course there will be extra training. Just as an older ophthalmologist must learn new techniques. If a new procedure or laser such as LASIK or SLT comes out after an OMD graduates they have to learn just like any other medical professional. Similar to how an OD would have to take a course or observe and practice the procedures.

I think the main problem I have is organized ophthalmology and medicine don't believe we have the right to learn new procedure like they can. Somehow they have a magical ability that no one else does. I don't know why they should have any right at all to influence our practice.

If optometry wanted to create a surgical residency to expand their scope of practice they should be allowed to. As long as the training was comprehensive and of high quality, AMA lobby money should not be allowed to stop it.

Dentists can expand their offerings with extra residency training and the MDs don't cry. I don't see how any argument could not be made that it is anything but money.

Look, I don't want to do cataract surgery or LASIK (definitely not a fan) or membrane peels. I do think that if optometry wanted to expand and had quality ways of further training it should be an option for those who want.

 

[JaggerPlate]

Nobody is saying optometrists that haven't been trained on the procedures is going to do them.

Though, as of now, it's technically legal to do them??

Just as an older ophthalmologist must learn new techniques. If a new procedure or laser such as LASIK or SLT comes out after an OMD graduates they have to learn just like any other medical professional. Similar to how an OD would have to take a course or observe and practice the procedures.

In my mind, the difference is that the OMD has attended medical school and, despite being out of residency for some time, still has the necessary 'base' of knowledge to build and expand upon that he received in a surgical residency. He isn't learning surgery THEN learning how to operate the newest laser; he's learning how to operate the newest laser with all the knowledge and experience he's had as a surgeon for X number of years.

I think the main problem I have is organized ophthalmology and medicine don't believe we have the right to learn new procedure like they can. Somehow they have a magical ability that no one else does. I don't know why they should have any right at all to influence our practice.

I don't think any MD/DOs don't think you have the capability to learn, but I do believe this 'magic' ability that you're referring to is frankly attending medical school and completing a surgical residency. It's not really a 'we have a RIGHT and you don't,' it's more 'the norm/safest way of performing eye surgery is to attend medical school, obtain a license to practice medicine, complete a surgical residency, and then practice surgery (after meeting board standards).'

Furthermore, many individuals have pointed out that issues with ODs simply learning how to operate the laser is that they don't possess (not trying to be offensive here) the knowledge/skill base forged in medical school/residency to deal with, diagnose, and repair when the mundane turns sour and it's time for emergency care.

If optometry wanted to create a surgical residency to expand their scope of practice they should be allowed to. As long as the training was comprehensive and of high quality, AMA lobby money should not be allowed to stop it.

I find it a bit ironic that you don't think AMA money should be able to stop it, but you DO think AOA (American Optometric) money should be able to allow it. If people want to say the entire situation is about money/power, etc, then we need to be completely fair and say that both sides of the coin are using this to get what they want.

Furthermore, what do you say to the questions regarding patient safety? Should chiropractors be able to expand their scope into ortho/neuro spinal surgery? Should midwives expand their scope into GYN reconstructions?

There definitely is a downside to groups simply being able to wield their own power and expansion in anyway they would like (medicine could be just as guilty here as well). At some point in time, the feelings of what a certain group wants/feels they deserve simply trump common sense and good medicine, and this is where additional roadblocks may be necessary.

Dentists can expand their offerings with extra residency training and the MDs don't cry. I don't see how any argument could not be made that it is anything but money.

Are you referring to oral maxillary facial surgery? If this is the case, it's actually a program where a DDS enters a surgical residency and, through extensive, brutal training, actually earns an MD while completing the training. So again, it's definitely much more regulated and integrated than dentists simply deciding they want to operate on the facial bones and doing it because 'nobody should be able to tell them otherwise.'

I do think that if optometry wanted to expand and had quality ways of further training it should be an option for those who want.

Devil's advocate here: couldn't appropriate training simply entail going back to medical school, completing a Ophthalmology residency, and doing it the 'old fashion' way, because that's what's essentially 'proven' (for lack of a better term) and not necessarily based on what people 'want?'

 

[Coastie]

Wow.

I hope the optometrists are honest in their advertising practices for patient's sake.

Why do midlevels push for things that they don't have training for?

Where are the university based surgery residencies for these kentucky cowboys?

If any patient is reading this, please, please, stick to real eye surgeons for your care: Ophthalmologists, who are MD/DO, not OD, and undergo rigorous medical and surgical training.

BTW, "OMD" reeks of a midlevel abbreviation much like "MDA" by the militant nurse anesthetists.

Can you imagine, an OD doing eye surgery with a solo CRNA at the helm? Smells like the future of healthcare!

 

[IndianaOD]

Devil's advocate here: couldn't appropriate training simply entail going back to medical school, completing a Ophthalmology residency, and doing it the 'old fashion' way, because that's what's essentially 'proven' (for lack of a better term) and not necessarily based on what people 'want?'

I wouldn't have a problem with it if it was done correctly. Similar as the dentists who "become MDs". As it is now I would have to repeat a bunch of classes I already took (many taught by MDs or PhDs). If ODs only had to repeat the medical education they did not get I think it would be fair. I certainly would not want to be re-learning primary eye care next to a first year ophthalmology resident that doesn't even know what a gonio lens was or how to get a clear image through a slit lamp.

While I do not believe all that work should be required for simpler laser procedures and injections I think it could be for cataract surgery, etc.

I could also see an OD completing a 1-2 year medical/surgical bridging program and a 1-2 year residency for more advanced surgery.

As it is no sane person could compare the risks and technical skills of a YAG or SLT to cardio-thoracic surgery. I really think it is a stretch to say that a medical surgical residency would make you any better at those procedures at all. Heck, tatoo and piercing artists do more invasive procedures than half of this stuff. I have spent time in the OR with first year ophthalmology residents (after the surgical year) and they didn't have a clue when they first started doing the ocular procedures.

I had an OD/OMD basically tell me while he was performing PRP: "I don't have any idea why ODs aren't doing this stuff yet, it isn't hard"

 

[JaggerPlate]

I could also see an OD completing a 1-2 year medical/surgical bridging program and a 1-2 year residency for more advanced surgery.

Just for perspective, an OMFS residency (to my knowledge) is 6 years. I don't think a 2 year OD -> Ophthalmologist + MD option would be realistic. However, I definitely understand not wanting to retake certain courses.

I had an OD/OMD basically tell me while he was performing PRP: "I don't have any idea why ODs aren't doing this stuff yet, it isn't hard"

Unfortunately, just an anecdote of 1 doc which, from what I've seen here, definitely doesn't necessarily reflect the whole of the medical community.

 

[Commando303]

I wouldn't have a problem with it if it was done correctly. Similar as the dentists who "become MDs". As it is now I would have to repeat a bunch of classes I already took (many taught by MDs or PhDs). If ODs only had to repeat the medical education they did not get I think it would be fair. I certainly would not want to be re-learning primary eye care next to a first year ophthalmology resident that doesn't even know what a gonio lens was or how to get a clear image through a slit lamp.

[...]

I could also see an OD completing a 1-2 year medical/surgical bridging program and a 1-2 year residency for more advanced surgery.

I began a thread a little while back (http://forums.studentdoctor.net/showthread.php?t=783679, http://forums.studentdoctor.net/showthread.php?t=783681) on this topic — "mobility" within eyecare. The thread received a lukewarm response, but I wonder if it's a topic for discussion, here. I do feel there ought to be mechanisms by which O.D.s can go on to practice as ophthalmologists without running through all of med. school. To my understanding, there's great overlap between the first two years of optometry and medical education, and a good amount of what's taught early in O.M.D. residency mirrors basic optometric tenets and procedures.

Is it really so unreasonable for O.D.s who're interested in expanding what they can practice, to be able to do so without "starting from scratch"? Would anyone claim an optometrist looking to enter ophthalmology knows an insignificant amount of what she or he would enounter on the traditional path to the career?

 

[swizz]

Hmm, if maxillofacial surgeons (the ones with the 6 yr residency) can get an MD, can't optometrists do something similar to that? (4 years undergrad -> 4 years optometry school -> 4 year specialty in x + 2 years for the MD degree? Just wanted to throw an idea out there, I have no intention of stirring up anything.

 

[Shnurek]

Can any of the real physicians explain the jump in admissions GPA's from class of 2008 to present?

http://www.sunyopt.edu/admissions/od_demographics.shtml

Looks like people are realizing what the future entails

Na, but really I'd like to know your rational opinion. I have stated mine.

 

[orbitsurgMD]

Can any of the real physicians explain the jump in admissions GPA's from class of 2008 to present?

http://www.sunyopt.edu/admissions/od_demographics.shtml

Looks like people are realizing what the future entails

Na, but really I'd like to know your rational opinion. I have stated mine.

Come on, one state school. Looks like an anecdote.

Maybe it means they are getting more applicants who might have gone to other more expensive schools deciding to spend less and go to a state school, or . . .

Maybe it means the school has done a better job than others in soliciting better candidates, or . . .

Maybe it means students who might have gone into other kinds of schools before, like dental school, for example, are not getting admitted, or . . .

Maybe more applicants with better grades are looking at professional schools in a severely down economy, for want of other opportunities, or . . .

Maybe it is just a fluke.

 

[KHE]

Though, as of now, it's technically legal to do them??

I'm largely ambivalent about this whole issue but I don't understand why you're so hung up on the "technically legal" aspect of all of this. You've mentioned it more than a few times.

It's "technically legal" for ophthalmologists to do anything they want as they have an unrestricted medical license but you don't see them running around like lunatics doing Whipples and bypasses and knee replacements.

 

[Shnurek]

Ever thought more people are choosing optometry school now over medical school even though they would have gained admission to both? A lot of my peers ever since Day 1 in undergrad were always like MED SCHOOL, MED SCHOOL, MED SCHOOL, without even researching other options. They just do it because everyone else does it.

Now I'll throw out some maybes too lol

Maybe eyes are what people are set on during undergrad.

Maybe people don't want to spend 4 years of medical school learning extraneous information like how to do a prostate exam. (And trust me a lot of my friends in med school are complaining they aren't really learning anything useful at this point) Like with organic chemistry (that we can all relate to), which surgeon remembers the details of an SN1 reaction by the time they are doing appendectomies for example.

Maybe specialists like ophthalmologists are going to get owned by obamacare.

Are matriculants to med school intelligent? Yes, very.
Is med school harder? Yes.
Should ophthalmologists bash and keep optometrists down even though they want to learn more and help patients in more diverse ways that have low-risk of injury with the advent of new technology? No.

 

[200UL]

I'm largely ambivalent about this whole issue but I don't understand why you're so hung up on the "technically legal" aspect of all of this. You've mentioned it more than a few times.

It's "technically legal" for ophthalmologists to do anything they want as they have an unrestricted medical license but you don't see them running around like lunatics doing Whipples and bypasses and knee replacements.

No - any reasonable hospital would not let me perform whipples and bypasses and knee replacements.

However, when you want to do your first YAG or SLT, sight path (or whatever it is called) will come running to assist- I can tell you if you give them the $100 dollar click fee per YAG, they will tell you that you are the best surgeon around (too bad there will only be about $80 left over for you).

I personally believe that if optometry has access to YAGs, SLT, ALT it would likely drive down the payments of these procedures. This point has been made before, but there will be without a doubt more utilization (some appropriate use, some perhaps inappropriate). As a procedure is coded for more often, medicare typically will pay less each year (ie intravitreal injections and OCT have taken major hits recently - injections could become money losers if this trend continues - they are definately money losers now if even one of your patients does not pay for the lucentis). Therefore, be careful what you ask for in future bills - before you pick up the skills needed for the surgery, it may be a money loser. Just something to think about....