Future of Ophthalmology?

[John_Doe]

As a person very familiar with Ophthalmology, I would be much more cautious choosing this profession in the current political environment given the relentless lobbying effort of optometry (which even begins with thier training) to gain the surgical priv. of Ophthalmology. This has gone on for years, but the recent two defeats (listed below) may be the straws that break the camels back. What do you think?

1.

July 30, 2004

VA Policy Alert

In spite of the coalition and your concerted efforts, the Veterans Health Administration today announced a new policy that permits optometric laser surgery within the VHA system.

2.
April 28th 2004

With the signing of H.B. 2321 on April 28, optometrists are now permitted to perform eye surgery with scalpels. The bill, which passed both house and senate days after it was introduced, also contains provisions that allow optometry to self-regulate its members.

?This new law essentially converts optometrists to ophthalmologists, ?said H. Dunbar Hoskins Jr., MD, Executive Vice President, American Academy of Ophthalmology. ?Moreover, it raises serious patient safety and quality care issues.?

The new law will seriously impact patient care, and not just in Oklahoma.

?What is going on in Oklahoma threatens quality patient care everywhere and cannot go unchallenged,? said Allan Jensen, MD, Academy President. ?Legislating surgical privileges in Oklahoma will surely feed optometry?s hunger for these same privileges in other states.?

For example, optometry has used Oklahoma as a way to expand its scope to include surgery within the Department of Veterans Affairs health system, where the Academy is currently fighting a patient safety battle. Oklahoma stands alone as the only state where optometrists can currently perform any laser eye surgical procedure.

The ramifications of the new Oklahoma law for ophthalmologists and their patients are so severe that the Academy is working with the Oklahoma Academy of Ophthalmology and a united House of Medicine to fight this devastating assault on patient safety.

Through a backdoor legislative effort, the provisions, introduced by pro-optometry interests, were a last-minute insert to a conference bill that had broad support in the legislature. This move by optometry to take advantage of the end-of-session legislative rush in essence prohibited public debate on optometric surgical scope. The bill authorizes the Board of Examiners in Optometry?a body composed mainly of optometrists?to decide optometric scope of practice including the types of surgeries optometrists will be able to perform on the eye and face, including cataract surgery, plastic surgery, facial reconstruction and eyeball removal. With the bill signed, the Academy?s fight to preserve quality surgical care moves to the rulemaking process, where, along with its allies, the Academy will continue to battle for patient safety.
-------------------------------

I assure you that 10-20 years ago people would say that it was crazy to think something like the above would pass - now it has and this is only the beginning.

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Members don't see this ad.

 

[John_Doe]

H. R. 3473 says eye surgery at a Department facility or under contract with the Department may be performed only by an individual who is either a licensed medical doctor or a licensed doctor of osteopathy.

Members of the VETS Coalition include the American Academy of Family Physicians, American Medical Association, American Osteopathic Association, American College of Surgeons, American Academy of Ophthalmology and the American Society of Cataract and Refractive Surgery. These are the medical supporters of H. R. 3473, which was DEFEATED by intense optometric lobbying.

 

[Andrew_Doan]

If this continues, then there will be fewer general ophthalmologists, and ophthalmology residents will be forced to complete fellowships.

Regardless, if you're a good physician, then you'll always be able to find a job. I'm not worried about the future of ophthalmology.

 

[John_Doe]

Yes, if this continues then there will be a push to force certain qualifications for subspecialty procedures, which means more will opt for a fellowship. The procedures most at risk initially in my opinion by optometrists will be cataracts and refractive surgery (plus minus some of the laser surgery for other subspecialties). However, I am less optimistic that all will be rosey for ophthalmology. There are many fold more optometrists than ophthalmologists, which means a larger pool of surgical distribution, and also likely decrease in reinbursement in addition to less surgical volume per "doctor".

I still say optometrists have nothing to lose and everything to gain by pushing for a greater scope of practice, and ophthalmologists have all to lose, not to mention the quality of patient care if we believe that an MD/OD background is paramount to patient care.

 

[Andrew_Doan]

I still say optometrists have nothing to lose and all to gain by pushing for a greater scope of practice, and ophthalmologists have all to lose, not to mention the quality of patient care if we believe that an MD/OD background is paramount to patient care.

Definitely. This is why optometry is pushing so hard. They have much to gain!

 

[jkin]

If they have much to gain, doesn't that mean that we have much to lose? If more of us are forced to do fellowships the whole landscape changes. How can this not do serious damage to the job market, surgical volume, etc?

 

[JennyW]

Yes, if this continues then there will be a push to force certain qualifications for subspecialty procedures, which means more will opt for a fellowship. The procedures most at risk initially in my opinion by optometrists will be cataracts and refractive surgery (plus minus some of the laser surgery for other subspecialties). However, I am less optimistic that all will be rosey for ophthalmology. There are many fold more optometrists than ophthalmologists, which means a larger pool of surgical distribution, and also likely decrease in reinbursement in addition to less surgical volume per "doctor".

I still say optometrists have nothing to lose and everything to gain by pushing for a greater scope of practice, and ophthalmologists have all to lose, not to mention the quality of patient care if we believe that an MD/OD background is paramount to patient care.

I don't agree, and I think that Oklahoma is not the norm. I don't know of AND ODs who want "surgical" rights. Most of us just want to hang onto what we are already trained to do, and that is the "primary care" procedures that we are already trained to do. In my home state of New York, OMDs are constantly going to court to try to restrict our ability to remove foreign bodies, place punctal plugs, and use prostaglandins for the treatment of glaucoma, despite that fact that ODs have been doing these procedures for years without complications. I had a discussion with some collegues a few months back about YAGs and PIs. We all agreed that yes, they were simple procedures, and yes, we had all done some under supervision as part of our training, but a YAG is NOT a primary care procdure. If anything, it's a TERTIARY care procedure because it's something that is done AFTER an invasive surgery. Plus, I don't see a tremendous amount of patients that need YAGs. No OD that I know in private practice could afford to have a laser in their office. The volume is just too low. The volume is too low to have even four or five ODs sharing a laser.

Someone on another thread suggested that ODs not be allowed to prescribe systemic meds because we haven't gone through "the years of intesive training blah blah blah blah." I didn't realize that the streets were littered with corpses of people killed by Keflex that they got from their OD to treat their hordeolums.

I just had my first son two weeks ago. Being Jewish, a Mohel came and performed the ceremony at our home. Perhaps I should have "demanded surgery by a surgeon." I'm pretty sure the Mohel did NOT go through 4 years of college, 4 years of medical school, internship, blah blah blah.

Instead of having a discussion as to what constitues "surgery" why dont' we have an honest discussion as to what constitutes "primary eye care."

Is primary eye care....

Dilating the pupil?
Removing a foregin body?
Treatment of non complicated POAG?
Punctal Occlusion?
Kenalog for a chalazion?

Jenny

PS: To the person who was worried about the future of opthalmology, don't be. Every OMD I know is doing just fine, and is booked up weeks in advance, and I practice in an area that is moderately saturated.

 

[Retinamark]

I had a discussion with some collegues a few months back about YAGs and PIs. We all agreed that yes, they were simple procedures...
.

There is nothing simple about YAG PI's. There is no way optometrists should be doing these.

Someone on another thread suggested that ODs not be allowed to prescribe systemic meds because we haven't gone through "the years of intesive training blah blah blah blah." I didn't realize that the streets were littered with corpses of people killed by Keflex that they got from their OD to treat their hordeolums.

There are many ways you can kill a patient with inappopriate prescribing. Without medical training, you do not have the insight to know the indications and relative risk of various treatment alternatives.

Is primary eye care....
Kenalog for a chalazion?

Surgical procedures, including injections should never be performed by non medically trained people.


If you want to be an ophthalmologist go to med school !
If you don't want to go to med school, stick to prescribing glasses.

 

[mdkurt]

I don't agree, and I think that Oklahoma is not the norm. I don't know of AND ODs who want "surgical" rights. Most of us just want to hang onto what we are already trained to do, and that is the "primary care" procedures that we are already trained to do. I had a discussion with some collegues a few months back about YAGs and PIs. We all agreed that yes, they were simple procedures, and yes, we had all done some under supervision as part of our training, but a YAG is NOT a primary care procdure. If anything, it's a TERTIARY care procedure because it's something that is done AFTER an invasive surgery. Plus, I don't see a tremendous amount of patients that need YAGs. No OD that I know in private practice could afford to have a laser in their office. The volume is just too low. The volume is too low to have even four or five ODs sharing a laser.

Someone on another thread suggested that ODs not be allowed to prescribe systemic meds because we haven't gone through "the years of intesive training blah blah blah blah." I didn't realize that the streets were littered with corpses of people killed by Keflex that they got from their OD to treat their hordeolums.

I just had my first son two weeks ago. Being Jewish, a Mohel came and performed the ceremony at our home. Perhaps I should have "demanded surgery by a surgeon." I'm pretty sure the Mohel did NOT go through 4 years of college, 4 years of medical school, internship, blah blah blah.

.

JennyW, it's refreshing to hear these comments coming from an optometrist. I agree that a minority of optos are pushing for these rights, and most of you know that the profession is probably at its best right where it is. Unless everyone is going to do PIs for marginally occludable angles and ALTs that aren't indicated, the volume simply doesn't exist. Most ophthalmologists understand this, and look to their optical department, not their laser, to increase revenue. Optometry has an excellent mix of lifestyle, income, and responsibility right now. This will change if optometry continues to push into surgery.

Now for my rant of the day. Chalazions/hordeolums aren't infectious entities, and Keflex or any other antibiotic isn't indicated. Although rare, anaphylaxis does happen and patients have been killed by keflex. Is kenalog for a chalazion surgery? Sure it is. Loss of pigmentation, fat necrosis, and increased IOP are all potential complications. They happen rarely, but they do happen. I know that we MDs sound reactionary when we take this stance, but lack of respect for some very real potential outcomes is going to get you into trouble.

 

[mdkurt]

I forgot one thing. I'm not Jewish, and didn't know how to spell Mohle until your post. A good friend of mine invited my family over for his son's bris (sp?) and explained to me that a Mohle has to go through a rigorous training process including rotations with OBs and urologists. Obviously, there are historical and cultural reasons behind why a Mohle is performing circumcision, but adequate training is still there.

 

[maxwellfish]

I forgot one thing. I'm not Jewish, and didn't know how to spell Mohle until your post. A good friend of mine invited my family over for his son's bris (sp?) and explained to me that a Mohle has to go through a rigorous training process including rotations with OBs and urologists. Obviously, there are historical and cultural reasons behind why a Mohle is performing circumcision, but adequate training is still there.

That just shows that knowledge is not exclusive. ODs and other non-MDs can perform certain procedures and follow newer standards of practice with adequate training.

 

[JennyW]

I forgot one thing. I'm not Jewish, and didn't know how to spell Mohle until your post. A good friend of mine invited my family over for his son's bris (sp?) and explained to me that a Mohle has to go through a rigorous training process including rotations with OBs and urologists. Obviously, there are historical and cultural reasons behind why a Mohle is performing circumcision, but adequate training is still there.

Yes, but did they go through 4 years of college, 4 years of medical school blah blah blah?? Of course not! This just proves that allopathic medical training is not the only path to enlightenment. How is it that a mohle gets adequate training doing "rigorous training" and "rotations with OBs" but there is no possible way that an OD can have adequate training to do anything but prescribe glasses after 4 years? Mohles clearly don't go through the traditional allopathic medical model. I'm pretty comfortable that after 4 years of schooling specializing in the eye that I am competent to inject a chalazion. I've done 100s, and have yet to kill anyone.

Jenny

 

[JennyW]

There is nothing simple about YAG PI's. There is no way optometrists should be doing these.

There are many ways you can kill a patient with inappopriate prescribing. Without medical training, you do not have the insight to know the indications and relative risk of various treatment alternatives.


Surgical procedures, including injections should never be performed by non medically trained people.


If you want to be an ophthalmologist go to med school !
If you don't want to go to med school, stick to prescribing glasses.

*yawn* Yet another tired reaction from someone who thinks that allopathic medical education is the only possible path to enlightenment.

You should read my other post regarding Mohels. Why isn't the medical community up in arms about these "non medically trained people" running around all over the country performing invasive procedures on 8 day old boys?

Jenny

 

[Richard_Hom]

*yawn* Yet another tired reaction from someone who thinks that allopathic medical education is the only possible path to enlightenment.

You should read my other post regarding Mohels. Why isn't the medical community up in arms about these "non medically trained people" running around all over the country performing invasive procedures on 8 day old boys?

Jenny

1. Likewise, how come there are so many non-medical people doing botox injections?

2. Permanent eyeliner "eyelid" tatooing?

Richard

 

[Richard_Hom]

There is nothing simple about YAG PI's. There is no way optometrists should be doing these.

Dear retinamark,

I believe your viewpoint may be shaped by the optometric training of your native country. In many respects, the two countrie's optometric training are signficantly differently to include basic medical science training, clinical clerkships/externships and the availability of advanced training.

It is likely, therefore, that your recommendation regarding optometric scope of practice in your country may be appropriate.

In addition, I believe that your statement should also read "...Without medical school training..." rather "...Without medical training,..." The concept of medical training is broad in many respects and therefore may be confusing to this audience. Such a broad use might preclude anyone from performing anything if that were the case. I do believe that certain occupations do perform things like BCLS/CPR, AEF, etc, with appropriate "medical training" yet have not gone to medical school.

 

[mdkurt]

Yes, but did they go through 4 years of college, 4 years of medical school blah blah blah?? Of course not! This just proves that allopathic medical training is not the only path to enlightenment. How is it that a mohle gets adequate training doing "rigorous training" and "rotations with OBs" but there is no possible way that an OD can have adequate training to do anything but prescribe glasses after 4 years? Mohles clearly don't go through the traditional allopathic medical model. I'm pretty comfortable that after 4 years of schooling specializing in the eye that I am competent to inject a chalazion. I've done 100s, and have yet to kill anyone.

Jenny

Like I said, there are cultural and historic reasons why it is acceptable for mohels to circumcise children. They practically invented circumcision. The last time I checked, God had not commanded ODs to perform laser surgery.

 

[mdkurt]

1. Likewise, how come there are so many non-medical people doing botox injections?

Richard

I'm unaware of any non-medical people doing botox injections. Please enlighten.

 

[Richard_Hom]

I'm unaware of any non-medical people doing botox injections. Please enlighten.

I stand corrected. Non-physicians are not supposed to do use Botox. I think the controversy here is oral surgeons who are trying or are doing it. The added dispute is FP's doing it after taking a CE course. But non-physicians are using lasers for skin treatments.

Regards,
Richard

 

[Fermata]

Does it really take 3 years of post-intern training to learn to inject botox?

 

[GeddyLee]

Does it really take 3 years of post-intern training to learn to inject botox?

I don't know. But some may ask, does it really take 4 years of training to learn to refract a patient?

 

[Fermata]

I don't know. But some may ask, does it really take 4 years of training to learn to refract a patient?

Touche.

 

[JennyW]

I don't know. But some may ask, does it really take 4 years of training to learn to refract a patient?

No, it doesn't. But that's the point. Contrary to what many OMDs think (actually, it's mostly OMD residents), we aren't spending 4 years just doing refractions.

Jenny

 

[John_Doe]

"I don't know of AND ODs who want "surgical" rights. Most of us just want to hang onto what we are already trained to do, and that is the "primary care" procedures that we are already trained to do."

-- Then as Andrew already pointed out, put it in writing and do not leave the legislative language open to any type of surgery for an OD dominant board to make that decision

"PS: To the person who was worried about the future of opthalmology, don't be. Every OMD I know is doing just fine, and is booked up weeks in advance, and I practice in an area that is moderately saturated."

-- People should be booked weeks in advance for nonemergent surgery, and the current situation is not synonymous with a scenario where six times more people will be competing for surgery.

-- What are your feelings on trying to push for opticians to be able to refract for glasses and contact lenses? Furthermore, they could screen out some of the obvious ocular findings by slit-lamp and imaging technologies. For any questionalble findings, they could refer to ophthalmology.

 

[Andrew_Doan]

No, it doesn't. But that's the point. Contrary to what many OMDs think (actually, it's mostly OMD residents), we aren't spending 4 years just doing refractions.

Jenny

Jenny,

We understand that you do more than refractions, but not to the level necessary to care for systemic illnesses nor surgery. The arguments you are making are similar to the ones made by opticians in Canada:

http://forums.studentdoctor.net/showthread.php?t=118193

 

[JennyW]

Jenny,

We understand that you do more than refractions, but not to the level necessary to care for systemic illnesses nor surgery. The arguments you are making are similar to the ones made by opticians in Canada:

http://forums.studentdoctor.net/showthread.php?t=118193

I don't know of any ODs that are managing systemic illness. However, I am confident that we are more than qualified to manage and/or monitor the ocular manifestations of most systemic diseases.

I think we're still disagreeing as to what constitues "surgery", but I guess that's the nature of these forums.

Jenny

 

[JennyW]

"I don't know of AND ODs who want "surgical" rights. Most of us just want to hang onto what we are already trained to do, and that is the "primary care" procedures that we are already trained to do."

-- Then as Andrew already pointed out, put it in writing and do not leave the legislative language open to any type of surgery for an OD dominant board to make that decision

"PS: To the person who was worried about the future of opthalmology, don't be. Every OMD I know is doing just fine, and is booked up weeks in advance, and I practice in an area that is moderately saturated."

-- People should be booked weeks in advance for nonemergent surgery, and the current situation is not synonymous with a scenario where six times more people will be competing for surgery.

-- What are your feelings on trying to push for opticians to be able to refract for glasses and contact lenses? Furthermore, they could screen out some of the obvious ocular findings by slit-lamp and imaging technologies. For any questionalble findings, they could refer to ophthalmology.

While I certainly wouldn't leave it open to an OMD dominated board to make that decision, I wouldn't object to language that precluded "surgery" but we would need to have a reasonable definition of surgery. As I have already stated, in my home state of New York, OMDs won an injunction a few years back restricing ODs from performing foreign body removals because that was "surgery" even though ODs had successfully removed thousands throughout the state. It wasn't a coincidence that the state court judge who issued this injunction happend to have a brother-in-law who was an OMD. It was eventually overturned after 6 months, but for those 6 months, many patients were denied care from the doctor of their choice, for a problem that their doctor could easily have taken care of. IMHO, the removal of superficial foreign bodies, punctal occlusion, and the injection of chalazions with Kenalog does not constitute surgery. I would not object to restricting the use of lasers (even for refractive surgery). I am not, and I know of no OD who is interested in performing refractive surgeries. I think the few in Oklahoma are definately in the minority.

I would not object to opticians refracting or fitting contact lenses. In fact, I use a technician to refract in my office and do spherical soft contact lens fittings. (I do not have a dispensary in my office. I sell no materials except for about 3 low vision devices per month.) THere is nothing magic about putting a -2.00 diopter lens on a two diopter myope. What most ODs are objecting to is the fact that opticians in Canada are looking to use what is essentially an autorefractor to prescribe from, with no health screening of the eye. That's a much more legitimate objection than the OMDs who a few years back tried to convice the public that ODs would be blinding their patients with proparacaine, or killing them with tropicamide and patanol.

Would OMDs be comfortable with opticians "screening out obvious ocular pathologies?" If OMDs aren't comfortable with ODs doing anything beyond prescribing glasses, I find it hard to believe that they would be comfortable with a profession that doesn't even require licensure in many states to "screen out obvious ocular pathology."

Jenny

 

[Andrew_Doan]

In fact, I use a technician to refract in my office and do spherical soft contact lens fittings. (I do not have a dispensary in my office.

Jenny,

It sounds like you want to function as a general, non-surgical ophthalmologist. On the other hand, without comprehensive residency training, it is difficult to function as a general, medical ophthalmologist. Contrary to your claims of 40-50% of optometrists completing a 1-year "residency", less than 15% complete a 1-year residency. Why should your profession's scope of practice be expanded when ONLY a small percentage of your graduates are receiving additional training?

Optometry training is not adequate enough to make you all general ophthalmologists. I am not alone in this view. I was in Washington D.C. and this is the consensus of the majority of ophthalmologists who are leaders in my field. Optometry has also claimed a "no malpractice track record"; however, when the optometrist is sued, he/she often claims that it's not within his/her scope of practice. The lawyers then go after the physician instead. This is one of the main reasons why optometrists can claim years of no complications and pay only $400/year in malpractice.

Your claims of the perfect no malpractice record is an old strategy and unsubstantiated claim.

I am not, and I know of no OD who is interested in performing refractive surgeries. I think the few in Oklahoma are definately in the minority.

I'd like to believe you, but my poll states the opposite. Most of the ODs (although small number) answering the poll want surgical rights.

http://forums.studentdoctor.net/showthread.php?t=119156

BTW, I agree with you that FB removal, punctal plugs, and punctal dilation are non-surgical procedures. This is how the new VETS ACT Bill is phrased, which I support 100%. However, even with the new language, optometry gives it minimal support. Why? I think your optometry leadership has their goals set on: 1) becoming general ophthalmologists and 2) gaining surgical (e.g. cataract) privileges in the future.

 

[JennyW]

Optometry training is not adequate enough to make you all general ophthalmologists. I am not alone in this view. I was in Washington D.C. and this is the consensus of the majority of ophthalmologists who are leaders in my field. Optometry has also claimed a "no malpractice track record"; however, when the optometrist is sued, he/she often claims that it's not within his/her scope of practice. The lawyers then go after the physician instead. This is one of the main reasons why optometrists can claim years of no complications and pay only $400/year in malpractice.

Your claims of the perfect no malpractice record is an old strategy and unsubstantiated claim.



I'd like to believe you, but my poll states the opposite. Most of the ODs (although small number) answering the poll want surgical rights.

http://forums.studentdoctor.net/showthread.php?t=119156

BTW, I agree with you that FB removal, punctal plugs, and punctal dilation are non-surgical procedures. This is how the new VETS ACT Bill is phrased, which I support 100%. However, even with the new language, optometry gives it minimal support. Why? I think your optometry leadership has their goals set on: 1) becoming general ophthalmologists and 2) gaining surgical (e.g. cataract) privileges in the future.

Quite frankly, it doesn't matter what the consensus of the "leaders of your field is" These are the same leaders who contended that ODs would be blinding their patients with tropicamide, or killing them with patanol. I would bet that 95% of them have never set foot in a school of optometry, so their opinion is not without bias.

I also don't agree with your contention about malpractice. Many ODs have been sued and have had judgements against them. If I'm sued, but claim that whatever the issue is is outside the scope of my practice, no lawyer is going to say "oh Ok Doctor Jenny! We'll go sue someone else!" It will be left up to the jury to decide if my actions were reasonable based on prevailing eye care standards in the community. Optometrists are rarely sued though, because we do tend to practice very conservatively. Almost to a fault in some cases.

Jenny

 

[Richard_Hom]

Jenny,

It sounds like you want to function as a general, non-surgical ophthalmologist..."

Optometry training is not adequate enough to make you all general ophthalmologists..."

Dr. Doan,

The first isn't far-fetched. I don't believe optometrists, even the most "advanced" or "functional" don't want to be comprehensive ophthalmologists. However, there are many functions which optometrists can do "in place of the ophthalmologists'.

Here is a novel idea, though which I feel would quiet the masses on this issue.

1. Support optomeric participation on medical panels and insurance plans which allow for optometric examinations for the purpose of detecting and managing early diabetics (pre-laser treatment); glaucoma detection and management; cataract management (till surgical)

2. Support optometric staff membership and privileges at hospitals.

I think the legislative route has been attempted because the above two have been long denied to the majority of optometrists who want to practice in such fashion. The above two would accomplish the following: accommodate medical and surgical sentiments on oversight of practice and skills as would to any physician; promote interprofessional relationships which are not nearly as close as I would like.


Dr. Doan, the above two recommendations would go far in persuading the majority of optometrists toward your view point that the scope of optometry should be this or that.

IMHO of course

Richard

 

[JennyW]

I'd like to believe you, but my poll states the opposite. Most of the ODs (although small number) answering the poll want surgical rights.

http://forums.studentdoctor.net/showthread.php?t=119156

BTW, I agree with you that FB removal, punctal plugs, and punctal dilation are non-surgical procedures. This is how the new VETS ACT Bill is phrased, which I support 100%. However, even with the new language, optometry gives it minimal support. Why? I think your optometry leadership has their goals set on: 1) becoming general ophthalmologists and 2) gaining surgical (e.g. cataract) privileges in the future.

That may be how the VETS act is phrased now, but the initial bill was NOT phrased that way, so you may have to forgive us if we're a little bit cautious before throwing our support behind it.

If you feel that those are not surgical procedures, then I don't think that we are that far apart in our thinking Dr. Doan.

I still don't agree that people are looking for surgical privileges. I'm sure there is a very small minority who are, and some of them are surely vocal, and may even occupy positions of leadership in the field, but 99.9% of us are not interested in invasive surgery.

Jenny

 

[Tony.]

That may be how the VETS act is phrased now, but the initial bill was NOT phrased that way, so you may have to forgive us if we're a little bit cautious before throwing our support behind it.

If you feel that those are not surgical procedures, then I don't think that we are that far apart in our thinking Dr. Doan.

I still don't agree that people are looking for surgical privileges. I'm sure there is a very small minority who are, and some of them are surely vocal, and may even occupy positions of leadership in the field, but 99.9% of us are not interested in invasive surgery.

Jenny

I dont know. I'd be interested in surgery IF (AND ONLY IF) I was properly trained and qualified. I wouldnt want to goto medical school though....there's a reason why I chose optometry school! .... and if i finish OD school and have a patient that needs some kind of 'surgery' s/he better get the f*$* outta my chair and go see an OMD !

 

[GeddyLee]

Quite frankly, it doesn't matter what the consensus of the "leaders of your field is" These are the same leaders who contended that ODs would be blinding their patients with tropicamide, or killing them with patanol. I would bet that 95% of them have never set foot in a school of optometry, so their opinion is not without bias.

Jenny

JennyW....just curious, who are the leaders of the field? I would assume ophthalmologists are. So, no matter what the leaders say, you will dismiss as biased, unless it support OD expansion of priveleges?

And, as you say, 95% have never set foot in a school of optometry so their opionion is biased. I would imagine 95% of OD's have never set foot in medical school, so why should we defer to optometry's leaders to make decisions regarding scope of practice?

So who should make the calls? Legislature....yeah, they aren't biased. Unless you consider all the money optometry throws at them to get their bills passed as bias.

ha

 

[JennyW]

JennyW....just curious, who are the leaders of the field? I would assume ophthalmologists are. So, no matter what the leaders say, you will dismiss as biased, unless it support OD expansion of priveleges?

And, as you say, 95% have never set foot in a school of optometry so their opionion is biased. I would imagine 95% of OD's have never set foot in medical school, so why should we defer to optometry's leaders to make decisions regarding scope of practice?

So who should make the calls? Legislature....yeah, they aren't biased. Unless you consider all the money optometry throws at them to get their bills passed as bias.

ha

1) I don't know who the leaders in your field are. I guess they are who ever Dr. Doan was referring to at his meeting.

2) Optometrists are not trying to restrict nor roll back ophthalmologists scope of practice, so it doesn't matter whether they have set foot in a medical school or not. Optometry leaders can make decisions regarding scope of practice, because optometry is not obligated to consult ophthalmology. If you want to raise concerns at public hearings and legislatures, then go ahead.

3) Don't even talk about optometry throwing money at lawmakers. The AMA is one of the largest political donors in the country. Even more so than the NEA, or the National Association of Teachers. And maybe, just maybe, some of the bills were passed not just because optometry lobbied for them. Maybe they were actually good public policy. What a SHOCKER!

Jenny

 

[Andrew_Doan]

1) I don't know who the leaders in your field are. I guess they are who ever Dr. Doan was referring to at his meeting.

2) Optometrists are not trying to restrict nor roll back ophthalmologists scope of practice, so it doesn't matter whether they have set foot in a medical school or not. Optometry leaders can make decisions regarding scope of practice, because optometry is not obligated to consult ophthalmology. If you want to raise concerns at public hearings and legislatures, then go ahead.

3) Don't even talk about optometry throwing money at lawmakers. The AMA is one of the largest political donors in the country. Even more so than the NEA, or the National Association of Teachers. And maybe, just maybe, some of the bills were passed not just because optometry lobbied for them. Maybe they were actually good public policy. What a SHOCKER!

Jenny

Jenny,

The point Geddy is making is that some of your posts are ill-informed and make generalizations. For instance:

1) You make generalizations about ophthalmology, but yet don't know the "leaders" in the field. I know numerous ophthalmologists and not one backs the support of optometrists prescribing systemic medications (e.g. prednisone or narcotics) or perform surgical procedures. It's not within the scope of your practice.

2) You claim 40-50% of optometric grads are doing residencies when in fact less than 15% do.

3) The AMA is a strong political lobby; however, optometry is more aggressive than ophthalmologists. The average ophthalmologist gives less than $100 each to their PAC. Optometrists have historically given several fold more. Why? Optometry has everything to gain with their aggressive lobby. In fact, optometry schools often require/encourage their students to lobby. The last time I check, political lobbying is not a part of medical school.

Optometry has a much stronger political lobby than OMDs. Our PAC is outnumbered by optometrists 3:1 AND you all give more each year. Thus, while we fight for Medicare fixes and malpractice reform, optometrists fight for medications like Xalatan. Each year, you nibble at scope expansion until optometry achieves incisional surgery in 40-50 years. After that time, then you'll set up your own backdoor, second class, surgical "residencies" for optometric surgeons.

 

[JennyW]

Jenny,

The point Geddy is making is that some of your posts are ill-informed and make generalizations. For instance:

1) You make generalizations about ophthalmology, but yet don't know the "leaders" in the field. I know numerous ophthalmologists and not one backs the support of optometrists prescribing systemic medications (e.g. prednisone or narcotics) or perform surgical procedures. It's not within the scope of your practice.

2) You claim 40-50% of optometric grads are doing residencies when in fact less than 15% do.

3) The AMA is a strong political lobby; however, optometry is more aggressive than ophthalmologists. The average ophthalmologist gives less than $100 each to their PAC. Optometrists have historically given several fold more. Why? Optometry has everything to gain with their aggressive lobby. In fact, optometry schools often require/encourage their students to lobby. The last time I check, political lobbying is not a part of medical school.

Optometry has a much stronger political lobby than OMDs. Our PAC is outnumbered by optometrists 3:1 AND you all give more each year. Thus, while we fight for Medicare fixes and malpractice reform, optometrists fight for medications like Xalatan. Each year, you nibble at scope expansion until optometry achieves incisional surgery in 40-50 years. After that time, then you'll set up your own backdoor, second class, surgical "residencies" for optometric surgeons.

Dr. Doan, I respectfully disagree. You are right, I don't know any leaders in opthalmology. However, it was you who pointed out that at your meeting you met many who don't support the type of practice that you described. My point is that the opinion of those leaders in YOUR field doesn't matter to me. I'm sure they're great doctors, and fine people, but I'm also sure that these are the same "leaders" who tried to convince the public 20 years ago that optometrists would be blinding their patients with tropicamide if we were given the privilege of dilating patients. I'm not so sure that they are exactly coming at it from an unbiased perspective. That's not to say that optometric leaders aren't biased, but it's hard to make the argument that optometrists shouldn't have expanded scope of practice because "leaders in ophthalmology" don't think it's a good idea.

As Dr. Hom pointed out in a previous post, if ophthalmolgy was a little bit more level headed about some of our practice expansion, then we wouldn't have had to go the legislative route. I told you the story of my collegue who moved to Reno, Nevada and had difficulty getting licensed to treat glaucoma despite the fact that he had managed thousands of glaucoma patients in the VA system for a number of years. He had difficulty because the OMD he was working with was a jerk. Cases like that played out all over the country. So again, you have to forgive us if we don't fell like groveling at the feet of ophthalmolgy for the right to perscribe Xalatan.

You are right about residencies. I was wrong when I said 40-50% of new graduates do them. That was for my school, and I mistakenly extrapolated to the entire population. But I disagree with your number of 15%. You can't take the number of ASCO accredited residencies and divide by the number of graduates, because there are some optometry school graduates who are international and return to their home country. There are some that are in research programs and go on to masters and PhDs in vision science and never enter clinical practice. There are also some that go directly into industry. There are also some non-compensated residencies as WELL AS SOME THAT ARE DONE UNDER OPTHALMOLGISTS. I was told (I can't verify this) that ASCO will NOT ACCREDIT programs where the resident is under the supervision of anyone but an optometrist. So there are some OD residents working under the supervision of opthalmologists in programs that are not counted in ASCO statistics. So while I was likely wrong about the 50%, it's DEFINATELY higher than 15%.

I know of no school that requires political lobbying. Certainly it wasn't happening at the one that I attended. They all have student liasons to the AOA, so lobbying may be encouraged but I have never heard of it being required.

Perhaps opthalmology should consider diverting funds to lobby against optometry rather than trying to sqeeze more money out of Medicare. It's all about priorities, I guess.

Jenny

 

[Andrew_Doan]

Perhaps opthalmology should consider diverting funds to lobby against optometry rather than trying to sqeeze more money out of Medicare. It's all about priorities, I guess.

This comment is ironic because it's the same money optometry has been trying to squeeze into.

Trust me, you're going to see more funds to lobby against optometry. This is the consensus of the majority, not a few like you imply.

BTW, in regards to optometric residencies, show me your data. Show me the data from your school to start with. It seems that squeezing data from you is like pulling teeth. Also, you're not absolutely correct about ASCO not accrediting an optometric residency if headed by an MD.

http://www.opted.org/reslookup/display.asp?id=307

Daniel S. Durrie, M.D. is the program coordinator of the first optometric refractive surgery residency. He is the reason why you have this option.

 

[JennyW]

This comment is ironic because it's the same money optometry has been trying to squeeze into.

Trust me, you're going to see more funds to lobby against optometry. This is the consensus of the majority, not a few like you imply.

BTW, in regards to optometric residencies, show me your data. Show me the data from your school to start with. It seems that squeezing data from you is like pulling teeth. Also, you're not absolutely correct about ASCO not accrediting an optometric residency if headed by an MD.

http://www.opted.org/reslookup/display.asp?id=307

Daniel S. Durrie, M.D. is the program coordinator of the first optometric refractive surgery residency. He is the reason why you have this option.

I did not imply that this was the opinion of a minority. I'm fully aware that it is the majority opinion of OMDs, but again, these are the same people who tried to convince the public that the streets would be littered with people blinded by ODs who used tropicamide on them. I'm not so sure that ophthalmology should be the final arbiter of optometric scope of practice.

I also can't speak for the residency you sited. As I said in my original post, I was not 100% that ASCO was doing this. WHen I was a resident, they would NOT accredit a residency where the OD was reporting to anyone other than another OD. An MD can be the program head, like they are in many of the VA or IHS clinics, but in my time, residents immediate supervisor had to be an OD. Perhaps they have changed this policy, or perhaps there is an optometric supervisor at that program. I do not know.

In any event, this thread is way off topic. It was started by someone concerned about the future of ophthalmolgy, and I told them that they had nothing to worry about.

Jenny

 

[John_Doe]

--- Florida Society of Ophthalmology:

Specifically, the Oklahoma law (H.B. 2321) authorizes the Board of Examiners in Optometry--a body composed mainly of optometrists--to decide the types of surgeries optometrists can perform on the eye and face, including cataract surgery, plastic surgery, facial reconstruction and enucleations. Following its well-worn path, organized optometry will not be confining the provisions of this law to Oklahoma, but will attempt to push for similar privileges to be legislated in other states across the nation. In addition, the optometric lobby is aggressively using this statute to expand optometric privileges within the Department of Veterans Affairs, which operates the nation's largest integrated health care system, serving 25 million veterans. ***Nothing less than the future of our profession is at stake***. Donate today!

-- Americal Medical News:


. . .We are also inundated with the wholesale renaming of jobs to inflate the importance of job holders, obliteration of differences in training by using widely inclusive titles, and the substitution of government or other bureaucratic fiat for education and experience.

For example, last month the Oklahoma Legislature passed a bill that had a last-minute amendment by insertion. HB 2321 was originally "An Act Relating to the Oklahoma Pharmacy Act." The amendment includes the following sentence: "The practice of optometry is further defined to be non-laser surgical procedures as authorized by the Oklahoma Board of Optometry, pursuant to rules promulgated under the Administrative Procedures Act."

In plain English, Oklahoma optometrists now can perform non-laser surgical procedures on our patients. The scope of these procedures will be defined by the Oklahoma Board of Optometry. No licensed surgeon or surgery-accrediting board will have any say regarding the qualifications required to perform these procedures.

So much for medical school, residency, fellowships, etc. It would appear that the word "physician" is just a name, and that it would be selfish to deny to others the privileges of physicians -- or would it be? Is it possible that strict adherence to the privileges, qualifications and ethics demanded of physicians actually protect the public? We at the AMA would have to say, "Yes!"

No doubt there are individuals who feel that this issue is really not very important, and that we should be magnanimous and embrace everyone who wants to join us. I would submit that such an approach will lead to the very destruction of our profession.

If physicians feel that the privileges we have so dearly earned should be available to all for the asking, ***I can guarantee that there will be no profession left. History is replete with examples of the lesson that there comes a time when one must fight for those ideals and principles that he or she holds dear, or they will be lost.***

 

[GeddyLee]

1) I don't know who the leaders in your field are. I guess they are who ever Dr. Doan was referring to at his meeting.

2) Optometrists are not trying to restrict nor roll back ophthalmologists scope of practice, so it doesn't matter whether they have set foot in a medical school or not. Optometry leaders can make decisions regarding scope of practice, because optometry is not obligated to consult ophthalmology. If you want to raise concerns at public hearings and legislatures, then go ahead.

3) Don't even talk about optometry throwing money at lawmakers. The AMA is one of the largest political donors in the country. Even more so than the NEA, or the National Association of Teachers. And maybe, just maybe, some of the bills were passed not just because optometry lobbied for them. Maybe they were actually good public policy. What a SHOCKER!

Jenny

So, you think the optometry leaders, who do not have expertise in medicine, should regulate what medicines and surgical procedures optometrists are capable of performing? Where are they getting the expertise that make them credible, safe decision makers in this process? Of course this board will decide that cataract extractions and vitrectomies are safely within the realm of optometric practice. They have no training to show them why it wouldn't be safe.

Optometry doesn't consult ophthalmology? Jenny, you have obviously lost your head. Optometry has consulted OPH since the profession began, both for surgical and medical care of their patients. And if OD's start performing surgery, they are going to be consulting Ophthalmology for the training. I'm certain optometry will not start from scratch in developing surgical techniques and skills.

And maybe, just maybe, the optometrists could benefit from the advice of ophthalmology when it comes to deciding what skills and training are necessary to perform surgical procedures, because....optometry has no experience with this.

I would also like to know what you and your colleagues would think if family practice physicians and PAs and CRNP's started refracting patients. I can envision primary care providers providing this service to their patients. Would you argue they don't have the skills necessary? I would even say that a family practicioner would be more qualified to train and perform cataract extractions than an OD, because they have training in clinical medicine and surgery that OD's don't receive.

But, for the most part, my biggest concern is....why optometric surgeons? Why should medicare and other insurance companies pump money into programs designed to train a new breed of eye surgeons? We already have ophthalmologists to cover this. And, is there enough volume of patients to go around? Pretty soon, with OD's and OMD's all doing surgery, the number of cases available to each surgeon will drop. With a decrease in case load, proficiency suffers. Yet again at the detriment to the patient.

Why be greedy about your scope of practice? You want refractions, and clearly opticians can't do this (and some of your colleagues would say neither can OMD's), you want glaucoma managment, you want systemic medications, and now surgery. Sounds like you should have gone to medical school. I can't imagine why people want to change their profession to the degree that optometry wants.

Did you all not enter optometry school with a clear idea of what you would be doing in practice? Or were you wooed by the promise of increasing scope of practice and surgical priveleges just over the horizon?

Sorry if my post is harsh, but thousands of folks graduate from medical school each year because they wanted to practice medicine safely and appropriately. It's very agitating to see other health professionals trying to sneak in the backdoor and practice the same as my colleagues and me.

No one here is arguing that punctal plugging constitutes sugery. But this isn't what you profession is fighting for. And why does the OK bill prohibit only laser surgery? So optometrists are able to do enucleations, but not YAG a posterior subcapsular cataract? I would bet that pretty soon OD's in OK will be doing lasers, then argue that if they are permitted to use the scalpel, then why not the laser.

And it won't stop. Now that there will be a precedent, psychologists will argue for prescription medications. PA's can argue for elective laparascopic surgical priveleges. Opticians care argue for refraction. Nurse midwives will argue for c-sections. And I was upset when I heard of FP's trying to remove corneal foreign bodies....

 

[Andrew_Doan]

Perhaps opthalmology should consider diverting funds to lobby against optometry rather than trying to sqeeze more money out of Medicare. It's all about priorities, I guess.

Fighting optometric expansion of practice is a high priority:

Academy Continues Fight for ?Surgery By Surgeons? in the Sooner State

Out of concern for patient safety, the Academy has been working with Eye M.D.s in Oklahoma to fight for patient rights to surgery by surgeons. Concern arose following the passage of a state bill allowing optometrists to perform eye surgery with scalpels.

More disturbing is that the new law allows optometry to regulate itself. The Academy has launched a concerted effort to educate citizens of Oklahoma on the differences between ophthalmologists and ?optometric physicians,? a moniker optometrists use in Oklahoma. Under the new law, Oklahoma optometrists have the broadest scopes of practice in the United States, including anterior segment laser surgery procedures and non-laser surgery procedures.

 

[GeddyLee]

It's great how optometrist in OK, being so skilled and equally well equipped to perform surgery, must stoop to the level of confusing the public with "optometric physician".

Why not call a spade a spade and just stick with the term "optometrist"? Why the need to confuse the public about their training? Most people would assume that a physician is someone who completed medical school, ie DO or MD. Oh that's right, OD's take an intensive 4 years of lecture about diseases of every system. I can tell you from experience that lectures are useful, but will never substitute for clinical experience, which is why ophthalmologists, and many other specialties, must complete an intern year.

Hey, OD's don't have clinical experience with anything other than optometry, and even that is likely heavily weighted toward generally healthy eyes. That's just my experience though.

And finally, medicine is more highly selective in it's people than optometry. Fair or not, only graduates of medical school should be doing surgery. The highest responsibility should go to those who have the best training and the best credentials. If medical training continues to be devalued at the hands of health professionals seeking greater scope of practice (you may as well say higher salaries), then why would the MD or DO degree be useful to anyone?

I've always said you could probably train anyone to do any kind of surgery, even if they don't have any education at all. But the problem comes when there are complications, or unusual co-morbidities, or other unforseeable situations that develop intraoperatively. In these circumstances only a high degree of clinical experience based broadly across all medical disciplines can provide the training and judgement necessary to act appropriately. Allied health fields do not train for the unusual or unexpected.

 

[Andrew_Doan]

If 4-years of optometry school is so comphrehensive, then how can the New England College of Optometry give out an OD to a Chemistry or Engineering PhD in ~2 years of school? If surgical rights are given to optometrists, then my college professors will be able to do surgery with 2 years of schooling...

The Accelerated Doctor of Optometry Degree Program
The Accelerated Doctor of Optometry Degree Program was established in 1972 to attract individuals possessing advanced knowledge and skills who could provide unique contributions though teaching, research, and clinical care. The Accelerated Degree Program is designed to provide an accelerated education for qualified applicants with either an earned doctorate in one of the biological, behavioral, or physical sciences, or a doctoral-level health profession degree. Graduates of the program are prepared to enter the profession in clinical practice, optometric education, or research. The program is conducted over nine consecutive academic quarters, thereby taking slightly more than two years to complete.

http://www.ne-optometry.edu/academic/aodp.asp

Applicants to the Accelerated Doctor of Optometry Program must hold doctorate-level degrees in a science or medicine. Graduates of the program represent such diverse fields as physics, psychology, anatomy, biology, chemistry, biochemistry, electrical engineering, biomedical engineering, dentistry, and medicine.

The Accelerated Program relies on the students' ability to perform concentrated independent study. Therefore, applicants must have demonstrated high scholarship in previous graduate study, as well as a firm career commitment to optometry.

 

[Tony.]

The AAO has about 27,000 members.

can someone give me the number of members there are in optometry? thanx

 

[maxwellfish]

If 4-years of optometry school is so comphrehensive, then how can the New England College of Optometry give out an OD to a Chemistry or Engineering PhD in ~2 years of school? If surgical rights are given to optometrists, then my college professors will be able to do surgery with 2 years of schooling...




http://www.ne-optometry.edu/academic/aodp.asp

Applicants to the Accelerated Doctor of Optometry Program must hold doctorate-level degrees in a science or medicine. Graduates of the program represent such diverse fields as physics, psychology, anatomy, biology, chemistry, biochemistry, electrical engineering, biomedical engineering, dentistry, and medicine.

The Accelerated Program relies on the students' ability to perform concentrated independent study. Therefore, applicants must have demonstrated high scholarship in previous graduate study, as well as a firm career commitment to optometry.

They still have to pass the classes and pass the boards. Receiving the OD degree does not guarantee you can practice... besides I think the accelerated program is geared towards research optometry not clinical optometry

 

[Andrew_Doan]

They still have to pass the classes and pass the boards. Receiving the OD degree does not guarantee you can practice... besides I think the accelerated program is geared towards research optometry not clinical optometry

We don't short track the MD route for MD-PhDs...

Graduates of the program are prepared to enter the profession in clinical practice...

The accelerated optometry grads can't be 'forced' to do research. They can hang a shingle like everyone else. If these guys can learn optometry in 2 years, then why are you all forced to complete a 4-year program?

 

[JennyW]

So, you think the optometry leaders, who do not have expertise in medicine, should regulate what medicines and surgical procedures optometrists are capable of performing? Where are they getting the expertise that make them credible, safe decision makers in this process? Of course this board will decide that cataract extractions and vitrectomies are safely within the realm of optometric practice. They have no training to show them why it wouldn't be safe.

Optometry doesn't consult ophthalmology? Jenny, you have obviously lost your head. Optometry has consulted OPH since the profession began, both for surgical and medical care of their patients. And if OD's start performing surgery, they are going to be consulting Ophthalmology for the training. I'm certain optometry will not start from scratch in developing surgical techniques and skills.

And maybe, just maybe, the optometrists could benefit from the advice of ophthalmology when it comes to deciding what skills and training are necessary to perform surgical procedures, because....optometry has no experience with this.

I would also like to know what you and your colleagues would think if family practice physicians and PAs and CRNP's started refracting patients. I can envision primary care providers providing this service to their patients. Would you argue they don't have the skills necessary? I would even say that a family practicioner would be more qualified to train and perform cataract extractions than an OD, because they have training in clinical medicine and surgery that OD's don't receive.

But, for the most part, my biggest concern is....why optometric surgeons? Why should medicare and other insurance companies pump money into programs designed to train a new breed of eye surgeons? We already have ophthalmologists to cover this. And, is there enough volume of patients to go around? Pretty soon, with OD's and OMD's all doing surgery, the number of cases available to each surgeon will drop. With a decrease in case load, proficiency suffers. Yet again at the detriment to the patient.

Why be greedy about your scope of practice? You want refractions, and clearly opticians can't do this (and some of your colleagues would say neither can OMD's), you want glaucoma managment, you want systemic medications, and now surgery. Sounds like you should have gone to medical school. I can't imagine why people want to change their profession to the degree that optometry wants.

Did you all not enter optometry school with a clear idea of what you would be doing in practice? Or were you wooed by the promise of increasing scope of practice and surgical priveleges just over the horizon?

Sorry if my post is harsh, but thousands of folks graduate from medical school each year because they wanted to practice medicine safely and appropriately. It's very agitating to see other health professionals trying to sneak in the backdoor and practice the same as my colleagues and me.

No one here is arguing that punctal plugging constitutes sugery. But this isn't what you profession is fighting for. And why does the OK bill prohibit only laser surgery? So optometrists are able to do enucleations, but not YAG a posterior subcapsular cataract? I would bet that pretty soon OD's in OK will be doing lasers, then argue that if they are permitted to use the scalpel, then why not the laser.

And it won't stop. Now that there will be a precedent, psychologists will argue for prescription medications. PA's can argue for elective laparascopic surgical priveleges. Opticians care argue for refraction. Nurse midwives will argue for c-sections. And I was upset when I heard of FP's trying to remove corneal foreign bodies....

*sigh*

Geddy, you're a good man and I respect you. But I don't think you're reading my posts very carefully.

I never said that optometry doesn't consult ophthalmology. I said optometry is not under any obligation to consult opthalmology with respect to scope of practice issues.

I can't speak for my collegues, but I would not be worried if family practice physicians started performing refractions. I would argue that the don't have the skills, but I would admit that they could be learned with relative ease. I am not worried about it though. Refraction doesn't pay well, and the vast majority of them do not have the time it takes to do an adequate job. There was a PCP in my area who was sued by a managed care plan because he was billing for "comprehensive eye examinations" (92004) along with routine physicals. His "comprehensive exam" was taking acuities and direct ophthalmoscopy. Currently, his case is pending before the state medical board for fraudulant billing.

No one that I know went into optometry with the expectation of expanded scope of practice. My scope of practice has NOT been expanded in the 9 years I have been in practice in ANY of the states I am licensed in.

I appreciate that you say that no one considers punctal occlusion "surgery." However, under CPT codes, punctal occlusion, foregin body removal, dilation and irrigation, and even eyelash epilation are all considered SURGICAL procedures. OMDs have used the argument that since these are "surgical" codes, ODs should be prohibited from using them despite the fact that ODs have safely performed thousands of these. It is actually an ongoing battle here in New York as I have posted before, and it was this issue that precipitated the term "surgery" being inserted into the oklahoma bill. It was actually brought about by ophthalmologists who sought an attorney general's opinion regarding a pending pharmacy bill. I have posted that before.

In another one of your posts, you make reference to ODs using the moniker "optometric physician." Trust me on this one, NO OPTOMETRIST cares to use the title physician. That came about because in many states, 3rd party payors would NOT reimburse "non-physician" providers. It doesn't make much sense that I can't submit 99212 for allergic conjuntivites treated with patanol because I'm a "non-physician." That is the ONLY reason it was done in the states where that moniker is used. Perhaps a small number of insecure ODs get off by using that title, but again, 99.99% of us couldn't care less.

And again, I'm sure that there is a very small number of ODs who would like to perform surgery and some of them may be vocal. But 99.99% of us have NO INTEREST in performing invasive surgery. You are absolutely correct. We don't have the experience, and there isn't enough volume to go around. We're just tired of having to fight constant court battles with OMDs who want to restrict procedures that we have been safely doing for years. (this is what the original VA legislation proposed.) If this means we have to legislate for the right to be "surgeons" then I guess that's the way it is.

But just for the sake of argument, let's say that this legislation in OK actually does allow ODs to suddenly perform invasive surgery (which it doesn't). Do you actually think that ODs are so reckless that anyone would start performing surgeries that they have no training in? Cmon. Give us a little bit more credit than that. As we have discussed before, you have a license to perform brain surgery since a medical license is "carte blanche" but I'm sure you're not running around clipping aneurysms.

Jenny

PS: I had the opportunity to meet the real Geddy Lee in a bar in Toronto about 8 years ago. Very nice man. He even asked what I did for work, and when I told him, he asked me what the yellow bump on his eye was. (pinguecula.) lol.

 

[JennyW]

We don't short track the MD route for MD-PhDs...

QUOTE]

Not exactly true. The PCP who practices next door to my office had a PhD in biochemistry before entering medical school. He said that he was exempted from a lot of his first year courses because of it. (I think he want to Emory.)

Jenny

 

[Andrew_Doan]

We don't short track the MD route for MD-PhDs...

Not exactly true. The PCP who practices next door to my office had a PhD in biochemistry before entering medical school. He said that he was exempted from a lot of his first year courses because of it. (I think he want to Emory.)

Jenny

Please show me the policy on this. I don't know about the above circumstance, but ALL the PhDs and prior candidate degree applicants I know who go through medical school are required to repeat courses. Because schools integrate teaching of some clinical medicine into the basic sciences, it's a logistic nightmare to make sure students who are exempted from courses receive the proper preparation before advancement into the second year. With my experience, students complete the entire first year of pre-clinical medicine because: 1) they have to pay for a full year regardless of how many classes they take; 2) it'll make them stronger physicians in the long run.

Here is a statement from the Emory Site about award of the MD degree:

http://www.emory.edu/WHSC/MED/TEACHING/regulations.html

DEGREE REQUIREMENTS
To be eligible for the degree of Doctor of Medicine a student must:


1) have credit for four academic years in an approved medical school program, the last two having been at Emory University School of Medicine;

2) have a satisfactory standing in all courses required for the degree;

3) and be of good moral character.

The judgment of the faculty as to the fitness of an applicant for the degree is based not on scholastic achievement alone but also upon knowledge of character, health, general attitude, and professional conduct.

Take notice of policy #1. MD candidates must receive four academic years from an approved medical school program.

The award of exemption for PhD courses does not appear to be routine if at all official policy of Emory. Nevertheless, NEWENCO is willing to give a 2-year OD to a Mechanical Engineer. At least the Biochemistry PhD had some of the courses taught in medical school. I doubt a Mechanical Engineer had much background in the numerous courses being "exempted". What happened to the argument that ODs require 4 years of comprehensive education?

 

[Andrew_Doan]

But just for the sake of argument, let's say that this legislation in OK actually does allow ODs to suddenly perform invasive surgery (which it doesn't). Do you actually think that ODs are so reckless that anyone would start performing surgeries that they have no training in?

You're correct that ODs aren't going to jump into surgery... at first. However, with backdoor, second rate optometric 'surgical' training programs, they will. This is why ophthalmologists must fight this law.

 

[mdkurt]

I'd like to think that all optometrists are as ethical as you, but there was a funny thing that happened in Wisconsin in 2000 where the state optometric board decided that they could all perform PRK. There were 750 optometrists ready and willing to fire on corneas with little or no trianing. This doesn't seem to be motivated by the need to use a billing code or by access to care or the best interest of the patients. It seems to have been motivated by greed. That's why many ophthalmologists may not swallow your arguments regarding the motivations behind expansion of scope of practice.