Future of Ophthalmology?

[happy7]

As an Optometry student, it saddens me to read all the bickering between our two professions. We are supposed to be working together to provide care to patients, not arguing constantly.
And please do not use the argument that optometry students are in any way "second rate" (i am not quoting specifically from this post, but have seen it before). I graduated in the top of my class in high school and Magna Cum Laude from a highly respected college, and chose optometry for my own reasons. I did NOT apply to medical school, not get accepted, and then decide "well, i GUESS I can always become an optometrist!" I enjoy what I am doing, and have had wonderful role models. My classes are challenging, my classmates wonderful, and my professors are brilliant (and also teach at local medical schools). I am hard working, and believe I would have been successful in medical school as well. We all just choose whatever path is right for us, and should not be put down for that.
I hope to form great working relationships with OMDs in the future, and be able to team up and provide the best care possible for our patients.

---

Members don't see this ad.

 

[Andrew_Doan]

I am hard working, and believe I would have been successful in medical school as well. We all just choose whatever path is right for us, and should not be put down for that.
I hope to form great working relationships with OMDs in the future, and be able to team up and provide the best care possible for our patients.

Thanks for posting!

 

[GeddyLee]

As an Optometry student, it saddens me to read all the bickering between our two professions. We are supposed to be working together to provide care to patients, not arguing constantly.
And please do not use the argument that optometry students are in any way "second rate" (i am not quoting specifically from this post, but have seen it before). I graduated in the top of my class in high school and Magna Cum Laude from a highly respected college, and chose optometry for my own reasons. I did NOT apply to medical school, not get accepted, and then decide "well, i GUESS I can always become an optometrist!" I enjoy what I am doing, and have had wonderful role models. My classes are challenging, my classmates wonderful, and my professors are brilliant (and also teach at local medical schools). I am hard working, and believe I would have been successful in medical school as well. We all just choose whatever path is right for us, and should not be put down for that.
I hope to form great working relationships with OMDs in the future, and be able to team up and provide the best care possible for our patients.

I too think optometry is a terrific profession and actually have recommended it to friends who did not want to go throught medical school and residency, but wanted to help people. In fact, I recently worked with an optometrist and learned a lot. He was a terrific guy. Hey...if I had to do it all over again, I myself may have chosen optometry. It's not a personal attack on your profession, or the people within it. It is an attack on the policies set by a minority in your profession who will stop at no end to include surgical procedures in the OD scope of practice.

I'm sure you've read enough to understand our position. I'm opposed to any of the allied health professions increasing their scopes of practice. CRNP's, PA's, they are gaining independence through mal-informed legislation, rather than greater training. Perhaps scariest is watching nurse anethesthetists running complicated cases. Hey, I just think the greatest responsibilities should lie with the best trained, most responsible. I also think there is a lot to be said for fairness here. What a bummer to go through twice, or even greater, the number of years of training as a health professional who now does exactly what you do because of some legislation. And we all know it's just BS. Believe me when I tell you the OK governor didn't sign that bill because it was in the best interest of his people.

Just because many of you OD's have the grades and intelligence to get accepted to medical school (which I do believe to be accurate), doesn't mean you have the equivalent knowledge of a medical graduate. I hear a lot of this..."I could have gotten into medical school." Well, it just doesn't matter. I think when a lot of people mention that OD's are "second rate" (which is foul to do anyway), they mean that...hey...we went through a lot more stringent selection criteria, put in much more work into our degree, completed about twice the number of years of training as a practicing OD by the end of our residencies. So are OD"s second rate to OMD's?? At least, not nearly well as trained.

Besides, I take all comments, "oh I could have easily gotten in the medical school" with a grain of salt. I had a college GPA of 3.9, 2 peer-review publications and presentations, tons of volunteer work, MCAT's in the 30's, numerous awards and such malarky and a very respectable high school career. I didn't get accepted. So, before you make the contention that you could have done this or that, think again. Not that "could have" really even matters, but I happen to believe a lot of the selection revolves around just going through the process...which requires a lot of heart and hard work and determination.

 

[Andrew_Doan]

So, before you make the contention that you could have done this or that, think again. Not that "could have" really even matters, but I happen to believe a lot of the selection revolves around just going through the process...which requires a lot of heart and hard work and determination.

I agree with Geddy. Most people outside of medicine do not understand the difficulty of matching for a competitive residency like ophthalmology. If you think it's difficult to get into medical school, the ophthalmology match is several fold tougher. In addition, you're also competing with the top quartile of all medical students when you enter the ophthalmology match.

 

[Andrew_Doan]

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?

Geddy,

I think I found an answer to your question. The official ASCO guide for optometry promises scope expansion as do other optometry schools. For instance:
http://www.sco.edu/admissions/faq.asp

What is the outlook for the optometric market? How do I find a position after I graduate?

The outlook for the optometric market is strong. First, the scope of practice for optometry continues to grow, and thus creates more need for optometrists. Second, the "baby boomer" generation has begun to retire, so there will be significant opportunities as these optometrists retire over the next 10-15 years. Finally, and most importantly, optometry is defined as the primary care provider for eye and vision care. As the population grows, the need for primary eye care will increase proportionately.

http://spectacle.berkeley.edu/pdf/asco_career_guide.pdf

 

[Richard_Hom]

Geddy,

I think I found an answer to your question. The official ASCO guide for optometry promises scope expansion as do other optometry schools. For instance:
http://www.sco.edu/admissions/faq.asp




http://spectacle.berkeley.edu/pdf/asco_career_guide.pdf

Dr. Doan,

I doubt that the bulk of optometry students enter because they hope to do more surgery or expanded scope of practice.

Many schools require incoming students to "shadow" an optometrist for some length of time to gain familiarity with the profession. Since the most of the talk of "expanded scope" is OK, most other optometrists do not practice in that fashion and students, therefore, will have a more "balanced" view of the profession.

I will 'guess' that 90% of the profession still see "well" people where "expanded" scope isn't needed. What drives people to optometry are the flexibility of the profession, the hours and the possibility of a entreprenurialship.

IMHO of course,
Richard

 

[Andrew_Doan]

Dr. Doan,

I doubt that the bulk of optometry students enter because they hope to do more surgery or expanded scope of practice.

I will 'guess' that 90% of the profession still see "well" people where "expanded" scope isn't needed. What drives people to optometry are the flexibility of the profession, the hours and the possibility of a entreprenurialship.

Dr. Hom,

I think it is interesting that programs and ASCO try to promote optometry with the promise of scope expansion. You must admit, this sounds attractive to young candidates. Your input is always appreciated.

 

[maxwellfish]

Dr. Hom,

I think it is interesting that programs and ASCO try to promote optometry with the promise of scope expansion. You must admit, this sounds attractive to young candidates. Your input is always appreciated.

Dr. Doan~ I don't think its so much promise as it is fact. The optometry scope of practice HAS grown and it IS growing today.

 

[Richard_Hom]

Dr. Hom,

I think it is interesting that programs and ASCO try to promote optometry with the promise of scope expansion. You must admit, this sounds attractive to young candidates. Your input is always appreciated.

I agree that it sounds attractive but it only is attractive while in school. The reality is that less than 5% will practice in an environment that has them using their "expanded scope" more than 50% of the time.

I think what is attractive about optometry is what I alluded in another post about the different approaches of each profession. If one wants to accentuate the mercantile side of vision, then theiy can with beautiful optical dispensaries and assistants (m or f). If one wants to practice "prevention" of vision problems in children they can do so. Or low vision rehabilit ation. The profession affords its graduates that opportunity.

Thus, I proffer that there is less overlap between the professions as non-optometrists might think.

IMHO of course.

 

[carrigallen]

Interesting debate points on both sides. I do not know much about this. Turf wars seem to be increasing all over the place, but nowhere as much as opthalmology.

Just curious, I have always been curious why opthalmologists are trained to use surgical radiotherapy (like eye brachytherapy)? I've always wondered why these type of procedures are not also done by radiation oncologists.

Considering rad onc is trained to treat the totality of the human body (including the CNS), why is the eye excluded? Since rad onc has such a solid foundation in research on CNS tumors, why not have them be responsible for eye radiotherapy too..just curious.

 

[Andrew_Doan]

Interesting debate points on both sides. I do not know much about this. Turf wars seem to be increasing all over the place, but nowhere as much as opthalmology.

Just curious, I have always been curious why opthalmologists are trained to use surgical radiotherapy (like eye brachytherapy)? I've always wondered why these type of procedures are not also done by radiation oncologists.

Considering rad onc is trained to treat the totality of the human body (including the CNS), why is the eye excluded? Since rad onc has such a solid foundation in research on CNS tumors, why not have them be responsible for eye radiotherapy too..just curious.

The problem is that radiologists are not surgeons. One must be able to take down the conj, dissect posteriorly, and implant the radioactive plaque next to the tumor. This takes surgical skill and knowledge of eye anatomy.

 

[deltamed]

Turf wars are 95% economic and 5% patient safety. The optometrists could probably safely do some of the "surgical" procedures they are requesting, but why should the opthamologists let them, even if it's safe? Who cares if it's a mainly economic battle? Professionaly courtesy dictates that you shouldn't invade someones turf - it's rude, greedy, and low-down. If you do step on that turf they have every right to fight any way they can.

It happens a lot within medicine too... cardiologists taking chest films from radiologists, orthopods taking spine work from neurologists, interventional radiologists fighting with interventional cardiologits etc.

Physicians have lost so much lobbying power because of specialty fragmentation. The AMA used to have immense lobbying power but now physicians associate themselves more with their specialty than their profession. I guarantee thirty years ago the AMA would have the firepower to crush something like this optometry lobbying so quickly that optometrists would probably lose their eyeglass prescription rights as well Even now, if all physicians united behind opthamologists in their turf war it would be a bruising victory.

The best thing physicians could do for themselves is unite as a profession under the AMA instaed of by specialty.

 

[mdkurt]

Just curious, I have always been curious why opthalmologists are trained to use surgical radiotherapy (like eye brachytherapy)? I've always wondered why these type of procedures are not also done by radiation oncologists.

Surgery to place the plaque is done by an ophthalmologist, but the plaques usually are designed by rad onc.

 

[funkless]

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

Are you serious? What do you mean by "medical training?" A three day phlebotomy course? I wouldn't call that "medical training." A four year allopathic program? Don't you thank that's a little rigorous?

--Funkless

 

[John_Doe]

Ophthalmology and Optometry

The distinction between ophthalmology and optometry is a frequent source of confusion. In addition to the fact that both are concerned with eye care, several other factors contribute to this misunderstanding. One source of confusion stems from the fact that optometrists are often referred to as "eye doctors" although, unlike ophthalmologists, they do not have medical degrees.
An optometrist receives a Doctor of Optometry (OD) degree and is licensed to practice optometry, not medicine. The practice of optometry traditionally involves examining the eye for the purpose of prescribing and dispensing corrective lenses and detection and non-surgical management of certain limited eye diseases. There are considerable state-by-state differences (in optometric scope of practice) with some states permitting use of more pharmaceutical agents than others.

In comparison, the scope of an ophthalmologist's practice is much broader. An ophthalmologist is a medical doctor (M.D.) who specializes in all aspects of eye care including diagnosis, management and surgery of ocular diseases and disorders. The difference between the training of an optometrist and that of an ophthalmologist underscores the difference in the range of practice. An optometrist may have only seven years of training after high school, consisting of three to four years of college and four years in an optometric college. An ophthalmologist receives a minimum of 12 years of education, which typically includes four years of college, four years of medical school, one or more years of general clinical training, and three or more years in a hospital-based eye residency program, often followed by one or more years of subspecialty fellowship.

Beyond the study of correction of refractive errors, optometrists have limited exposure in training for patients with eye disorders or disease. In contrast, ophthalmologists have a full medical education, followed by extensive clinical and surgical training in ophthalmology, with thousands of hours devoted to care and treatment of a much larger volume of sick patients.
---------------------------------------------------------------------------

All I can say is hail to the PAC money - I am sure the general public would be outraged at HB2321 and scope of practice at the VAHs.
-JD

 

[John_Doe]

The following is the news article; just want to know your opinion on why this is such a success. Why not do the same with cataract, glaucoma, coneal, retinal surgery? Would that be something to applaud? Why even go through the hassle of getting an MD and going through residency if there is a back-door approach to getting these surgical priv?
--------------------------------------------------------------------------

The Department of Veterans Affairs' new policy regarding who performs laser eye surgery is welcome news to the AAFP.

The policy, announced Aug. 2, requires all therapeutic laser eye surgeries at Veterans Administration facilities to be performed under the supervision of an ophthalmologist in a manner consistent with Joint Commission on Accreditation of Healthcare Organizations standards. Only optometrists who are fully trained and appropriately licensed will be granted clinical privileges by the department to perform therapeutic laser eye surgery under the supervision of an ophthalmologist.

The Academy has worked with other health organizations to seek a uniform standard of care throughout the Veterans Administration for performing the procedures. The new policy is already in effect.

"The Academy is pleased that the VA has adopted this important policy," said AAFP Executive Vice President Douglas Henley, M.D. "It is entirely consistent with our long-held policy and belief that nonphysician health care providers should always work under the supervision of a licensed physician."

The laser surgery controversy arose when the ophthalmology, medical and veterans' communities learned that in April 2003, an Oklahoma-licensed optometrist in a Kansas Veterans Administration facility was allowed to perform laser eye surgery on veterans, contrary to Kansas law. The Academy joined with more than 140 organizations in raising patient safety concerns within the medical community and among veterans.

"Our members have consistently expressed the need and desire for the AAFP to work on their behalf on matters that potentially affect the 'scope of practice' of all physicians, not just family physicians," Henley said. "This is an example of doing just that."

Currently, Oklahoma is the only state that licenses optometrists to perform laser surgery. The Department of Veterans Affairs will continue to evaluate and consider state and national standards of practice as it sets its own standard of care, the agency said.

"Our department has no higher priority than to ensure veterans receive the highest possible quality health care at all of our facilities," said Secretary of Veterans Affairs Anthony Principi in a press release. "This new policy will provide an additional level of safety for our patients who come to us for eye care."

 

[John_Doe]

Here is a news clip from the VAH site:

VA Establishes New Laser Eye Surgery Policies
August 2, 2004


WASHINGTON -- The Department of Veterans Affairs (VA) has announced a new policy providing a single, uniform standard of care throughout the Department for performing laser eye surgery procedures.

?Our Department has no higher priority than to ensure veterans receive the highest possible quality health care at all of our facilities,? said Secretary of Veterans Affairs Anthony J. Principi. ?This new policy will provide an additional level of safety for our patients who come to us for eye care.?

VA?s new policy states that all therapeutic laser eye surgeries at VA facilities will be performed under the supervision of an ophthalmologist in a manner consistent with Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards.

***Only optometrists who are fully trained and appropriately licensed*** will be granted clinical privileges by the department to perform therapeutic laser eye surgery under the supervision of an ophthalmologist.

Presently, Oklahoma is the only state that licenses optometrists to perform laser surgery. VA will continue to evaluate and consider state and national standards of practice as it sets its own standard of care.

VA currently operates 158 hospitals, 132 nursing homes, 42 residential rehabilitation treatment programs, and 854 outpatient clinics. The new policy will take effect immediately at all facilities with the capability to perform laser eye surgeries.
----------
*** I always thought that fully trained and licensed meant being an MD - I guess that is not the case anymore. Ophtho appears to be trashing its own profession.

 

[Andrew_Doan]

*** I always thought that fully trained and licensed meant being an MD - I guess that is not the case anymore. Ophtho appears to be trashing its own profession.

At least optometrists must act under supervision of an ophthalmologist. As long as ophthalmology remains in charge of surgery, then this will be a win-win situation for all.

 

[Mirror Form]

The following is the news article; just want to know your opinion on why this is such a success. Why not do the same with cataract, glaucoma, coneal, retinal surgery? Would that be something to applaud? Why even go through the hassle of getting an MD and going through residency if there is a back-door approach to getting these surgical priv?

This is somewhat of a success b/c the standard of care is not being totally compromised by allowing non-physicians to have complete reign over laser surgery. Although, I'm wondering what they mean by "supervise." If the ophthalmologist has to physically be there, he might as well just do it himself anyway. Or does supervise mean "on call?"

And are you suggesting that we should replace all surgeons w/ "surgical technicians?" Following your line of logic, why should just optometrists be the one to do the operations? Why bother training someone in all that refraction, physics, and extra schooling? Wouldn't it make much more sense to just hire someone off the street, and then teach them the anatomy and surgical steps? That's what your line of logic would dictate. Why would it be just optometrists who could perform these surgeries?

I think that it's fine to have PA's and whoever else "assist" with surgery under the supervision of a surgeon, but each operation still has a dedicated surgeon to it. This is the standard of care and most people getting operated on feel this is a good idea. I wonder what you'd prefer if your mother got a serious retinal detachment . . . would you rather have a fully trained ophthalmologist who completed a two year retina fellowship perform the operation, or have a technician perform the operation while the retinal surgeon is at home?

Regardless, there is no way I'll ever be accepting the legal liability for an operation done by somebody else, especially a non-physician!

 

[John_Doe]

I agree with you. My views on who should perform surgery at VAHs etc are the same as those at http://www.vetscoalition.org/?topic=facts. I am sure that the policy makers who are pushing for optometrist to perform surgery in VAHs would choose an ophthalmologist to perform surgery on their mother. HB 2321 and the VAH issues may lead to vast changes in the field of ophthalmology, and thus, I brought up this topic in a medical school forum so that people interested in the field could see what might affect their future, before choosing to get into it. Personally, I am glad to be in my field, but am very concerned, and feel anyone interested in ophtho should be concerned as well.

 

[John_Doe]

The situation in OK and VAHs is like no other in the history of ophthalmology, and it is a huge deal. For instance, look at the last Washington Update sent by the AAO, which I will paste below:

VA establishes working group to implement optometric surgery directive
The Department of Veterans Affairs is moving forward with plans to allow optometrists to perform laser eye surgery under the supervision of ophthalmologists. It will convene a working group next month to determine how to implement the directive. Key issues requiring resolution include a determination of what constitutes supervision. If you are getting pressure to begin supervising OD surgery, contact the Academy's Washington office. VA facilities should not allow ODs to perform surgery before the working group develops guidelines.

Veterans will play key role in success of ?Surgery by Surgeons,? encourage your veteran patients to speak out
Please take the time to educate them about our concerns with the recent directive from the Department of Veterans Affairs allowing OD surgery under the supervision of an ophthalmologist, and urge them to voice their concerns with the VA.
--------------------

 

[John_Doe]

If HB 2321 and VAH etc are not fought and won, the situation in will be similar to what happened with podiatry. Here is a post from another bb:

#3) You asked,"What kind of controlled substance would you need to write
scripts for?"
Reply: "I'll answer that with an example:
if a patient came into my office with a gangrenous foot that needed to be
amputated, after the procedure, ordinary NSAIDS won't do - obviousy!
Any surgical procedure that involves the cutting of bone would warrant the
use of a controlled substance post-op (eg. Demerol, coedine, etc.)

#4) When I gave examples of some of the surgical procedures performed by
podiatrists(eg. ankle arthroscopic surgery, below-knee amputations)
you commented,"Maybe that would be best left to orthopedic surgeons"

Reply/Fact: Maybe I should have clarified that a little bit better. The scope
of practice of a podiatrists varies from state to state. North
Carolina is the most restrictive (thanks to the lobbying of greedy
orthopedic surgeons) in that a podiatrist is limited to forefoot
(below the ankle) procedures only. This is Definitely not the
norm. The most liberal state like Nebraska alows podiatrists to
operate anywhere below the knee, and in addition, a podiatrists can
do soft tissue (no bone) procedures above the knee up to the hip.
From what I heard, in Virginia, a DPM is limited up to and
including the ankle. Many states (like Florida) have enacted the
"Leg Law". Which gives podiatrists the power to operate anywhere
below the knee. Keep in Mind a person graduating with a DPM must
do a residency in order to get a license. DPM's who do
surgical residencies are fully trained and competent to do surgical
procedures below the knee and is Board Certified. So in NC, even
though the DPM who is board certified in podiatric surgery is fully
competent to procedures below the knee, the state legislature there
thanks to greedy orthopedic surgeons, have restricted them to
forefoot procedures only. If you have any question about the
ability of a podiatrist to to arthroscopic ankle surgery, go to
your library and pich up a copy of the Journal of Foot &
Ankle surgery. You will see that most of the people in that
journal are DPM's. If you check the membership roster of the
American College of Foot & Ankle surgeons, you will see that 95+%
of the fellows are DPMs.

Here is another posting:

From: Hwy sqrl ([email protected])
Subject: Re: Podiatry School Anyone?
View: Complete Thread (3 articles)
Original Format
Newsgroups: misc.education.medical
Date: 1996/02/06

I see some people are interested in podiatry school. I will try to give
some general answers to the previous post, but if you want to know all
about it, feel free to email me.

Easier to get in? Yes. Unfortunately, this is the case. This is also
why many MDs and DOs don't give us enough respect. Remember, however,
that while it is easier to get in, the workload is just as difficult.
Many students drop out in the first year because they didn't expect it to
be as difficult as it is.

Average GPA and MCAT? Usually about a 3.0 and 22. I think one of the
reasons the MCAT is so low, though, is because many who come to podiatry
school have a huge problem with standardized tests (and don't look forward
to the boards!). We also seem to have a number of students who don't
speak english very well (at least at my school). Obviously that lowers
the verbal reasoning scores.

How much do they make? Depends on how long you've been in practice and
where you practice. Some make around $50k a year. Others make over $1
million! As they say, location, location, location.

Are they physicians? Yes. The federal government defines podiatrists as
physicians. Some states do not because the wording in their laws only
defines a physician as someone who can treat the whole body. I forget the
breakdown, but I think that 38 of the 50 states define us as physicians.
Podiatrists are one of only four types of doctors (others MD, DO, and
DDS/DMD) who can prescribe medicine and perform surgery. We are trained
to diagnose and treat all ailments of the foot and ankle. In some states,
we can also work on the leg, up to the knee.

Can you go into orthopedic surgery? Not officially, but we do the same
work as orthopedic foot and ankle specialists. That includes all types of
surgery, both soft tissue and bone in relation the foot and ankle. We
also have the added advantage of receiving (ad naseum) biomechanics
training in our schooling which helps us to further understand the causes
of foot pathology and therefore to better treat it to prevent recurrence.
Orthopods get very little biomechanics training during their residencies.

That's about it.

Here are some podiatry web-sites:

http://www.podiatry.org/podiatry.html
http://www.apma.org

Again, feel free to email me at [email protected]. I'm very busy with
school, though, so please be patient waiting for a reply.

Jeff D.
California College of Podiatric Medicine, PMS II
-------------------------------------------------------------------
For example, the legislation to allow optometrists to do laser surgery in VAHs, will require a certain level of training. That training will allow optometrists to say why can't we do laser surgery anywhere, and hey, I have not had any complications, so I should be able to do it on my own. And why not get a little more training and start to do other types of surgery - maybe OK can offer that sort of training . . and on and on until the scope of practice for at least a general ophthalmologist will be the same as an optometrist - and then just as podiatrist are working their way up the leg to the knee and even the hip, optometrists will push to get rights to perform any of the subspecialties.

 

[Andrew_Doan]

For example, the legislation to allow optometrists to do laser surgery in VAHs, will require a certain level of training. That training will allow optometrists to say why can't we do laser surgery anywhere, and hey, I have not had any complications, so I should be able to do it on my own. And why not get a little more training and start to do other types of surgery - maybe OK can offer that sort of training . . and on and on until the scope of practice for at least a general ophthalmologist will be the same as an optometrist - and then just as podiatrist are working their way up the leg to the knee and even the hip, optometrists will push to get rights to perform any of the subspecialties.

Exactly. Optometrists are not going to do surgery overnight. They'll accomplish this step by step to form a backdoor, less competitive way into ophthalmic surgery. We have to take a stand and demand surgery by MDs and DOs only.

 

[John_Doe]

VA Policy: Optometrists Can Use Lasers ... Under Ophthalmologists? Supervision

Optometrists practicing within the Veterans Health Administration can perform therapeutic laser procedures, but only if they are fully trained, appropriately licensed?and do so under the supervision of an ophthalmologist, under a new policy announced by the department earlier this month.

In announcing the policy, Secretary of Veterans Affairs Anthony J. Principi said, ?Our department has no higher priority than to ensure veterans receive the highest possible quality health care at all our facilities.?

Sharon Atkin, O.D., president of the National Association of Veterans Affairs Optometrists, describes this policy as the better of two outcomes. ?The bottom line is that our director was told that there was no way that the VA would allow optometrists to be independently privileged to perform laser procedures,? she says. ?So he had a choice between putting out a directive that O.D.s could not perform laser procedures at all, or have the bill that we have now that O.D.s could perform lasers under supervision.?

Dr. Atkin adds that she hopes that by the end of the three-year period for this latest directive, ***?We will have O.D.s performing laser procedures under ophthalmologists, that it will prove they can perform these procedures and that it will lead to them being licensed.?***
This latest policy is in response to the proposed Veterans Eye Treatment Safety Act (HR 3472) being considered in Congress. The text of the legislation says that eye surgery at VA medical centers can only be performed by either a licensed medical doctor or doctor of osteopathy. The VETS Coalition?which consists of the American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, and various other medical groups?supports the legislation.

The coalition says the Act is in response to an Oklahoma-licensed optometrist performing laser eye surgery on veterans in a Kansas VA facility, even though this is beyond the scope of optometric practice in Kansas.

Optometrists, however, are concerned that the text of the legislation may include all minor procedures, including epilating eyelashes, punctal plug insertion and foreign body removal.

Ironically, only about three optometrists have been performing laser procedures at VA Medical Centers, with no adverse outcomes, Dr. Atkin says.
http://www.revoptom.com/index.asp?page=2_1240.htm

 

[GeddyLee]

Exactly. Optometrists are not going to do surgery overnight. They'll accomplish this step by step to form a backdoor, less competitive way into ophthalmic surgery. We have to take a stand and demand surgery by MDs and DOs only.

I agree....this is the trend for all mid-level providers. Physicians in general need to band together to fight against further expansion of mid-level scope of practice. Little by little, they become more independent, have greater scope and more responsible roles with the same, if not less training than in prior years. They all argue for seemingly insignificant expansions year after year until they practice just as a physician.

These are the dangerous steps of the infancy of a trend which will lead to technician based medical practice. CRNA's delivering anesthesia un supervised, surgically trained PA's doing their own cases, CNM's with surgical and medical priveleges, PA's and CRNP's with subspecialty training. It's all on the horizon if it's not stopped now.

OD's won't be happy being OD's...they want surgery. No matter how much they say they don't want surgery, I wouldn't buy it. It's the facade they use to mask their initiative. Sadly, people probably think short surgery equals easy surgery, and probably 75% of americans don't know the difference between an OD and a OMD anyway, which means no one is really going to give a crap except for OMD's. I think the AMA should use their lobbying power to put an end to all mid-level expansion.

The mantra of the trend will be lower cost healthcare and neither the government nor the people will care, because they all believe doctor salaries are responsible for high cost of health care. MD's will demand higher salaries because of their greater investment, both in terms of money, time, and personal sacrifice. A PA with 2 years of college and 2 years of PA school probably thinks making 100K is fantastic. Funny thing is, these midlevels probably demand higher and higher salaries since they are paid by an institution or a group practice. Physician salaries are instead dictated by the government and will continue to decline, as the powers that be decide physicians' skills aren't really all that valuable, despite the fact that it costs more and more to acquire those skills.

Sadly enough, they were all ultimately trained by physicians, which is why I will refuse to ever teach a mid-level at any point in my career. Expansion must stop now, or we will all be on equal ground with caregivers with only a fraction of our training.

 

[John_Doe]

The Role of the Modern Optometrist
In a previous issue, Samuel J. Simon, O.D., expressed his concern about the direction of optometric training and the profession?s emphasis on developing ?diagnostic doctors,? (Letters & E-mail, June 2004). While his observations regarding the history, evolution and current state of optometry are enlightening, I believe that his views reveal a misunderstanding of the reality of modern optometry.

Why must there be a division between ?vision care? and ?medical care?? Some O.D.s believe learning about medical eye care means turning our back on vision care. Why must the two be mutually exclusive? Medical eye care is a necessary and logical extension of vision care. We practice both ... and why not?

Dr. Simon said, ?Diagnosing eye pathology is certainly a part of our calling, but it is a small part of what the public wants from us.? I disagree. Our calling is to serve patients to the best of our ability. Depending on your patient base, that may mean a practice limited to vision care, but for others it may require practicing everything short of surgery. The latter simply manage a wider range of patient types. Modern O.D.s can be true primary care physicians, treating a variety of challenging and interesting cases.

An argument can be made that O.D.s are over-trained for the traditional job of optometry, but we must consider that optometry is still evolving. Students should be taught to the highest level of optometric practice in the U.S. Anything less would shortchange those who aspire to practice in states with advanced scope of practice laws.

Dr. Simon also admonishes our professional publications for falling into the ?therapeutic trap? and suggests that we cannot survive by focusing on pathology. In reality, the reverse is more likely. Over the last two decades, the cost of ophthalmic products for the public has decreased significantly, competition is greater and profit margins are thinner. Those who place all their apples in one basket may survive, but they may find it quite difficult.

In order for optometry to survive and flourish, we must offer a range of services to our patients and deliver those services with the highest level of skill and professionalism. ***That means including medical eyecare. The domain of optometry should be optical, visual and medical. Why? Because we have the ability to encompass all three. As long as we educate our students and ourselves with expertise and compassion, we will have more stimulating and rewarding practices. ?Cliff Courtenay, O.D., Valdosta, Ga., [email protected].

more: http://www.revoptom.com/index.asp?page=2_1239.htm

 

[MacGyver]

To all the opthos out there:

PLEASE PLEASE do not be fooled by this "supervision" BS. Its simply a back door way in.

What will happen is the following:

1) Full supervision by opthos

2) Gradual loosening of supervision rules

3) Eventually, "supervision" means "available by telephone" or "available by internet" and nothing more.

4) ODs patiently waiting, gathering data on clinical outcomes

5) After X number of years, ODs come out of the closet with all their clinical data and they will go to the state legislatures. They will point out that they've already been doing this stuff for years with no bad outcomes, and that the "supervision" they received was so lax that they might as well do it on their own.

Supervision ALWAYS results in a dilution of the requirements over time. When PAs first came into existence, the physician supervising requirements were very strict. Attendings had to be on site, they had to review ALL of the patients charts before treatment was initiated. Now, its totally different. In many states, "supervision" means that the attending reviews only 10% of the charts AFTER the patient has already been discharged; the attending is never on site, reviews all charts over the internet after the fact.

"Supervision" is a back door to surgical and enhanced medical procedures.

Unfortunately, the greed of opthos themselves will come into play. You will hear many opthos SUPPORT the supervision rules because it means they can bill for $$$. They can make even more $$$ by gradually adjusting the supervision rules to be very loose. Why supervise 1 OD on site when you can simultaneously supervise 5 of them from another site with no formal contact?

This introduces ENORMOUS incentive for opthos to let ODs squeeze in under these "supervision" rules, and then slowly but surely adjust "supervision" so that its no longer meaningful. The ODs then take advantage of this by running to the state legislatures and argue that "supervision" is a sham and that they should be allowed independent practice.

 

[MacGyver]

Modern O.D.s can be true primary care physicians, treating a variety of challenging and interesting cases.

This is the holy grail that everybody is after. ODs, dentists, chiropractors, PAs, NPs, naturopaths, psychologists, physical therapists are ALL clamoring for this title.

There is not a single non-MD healthcare group that does NOT want to expand their scope of practice into the domain currently occupied by only MDs and DOs. Everybody and their brother wants in on it, and doctors are asleep at the wheel.

 

[deleted6669]

wake up mac, pa's and np's are already working as pcp's and running small er's and have been for > 20 years in urban as well as rural areas. until every primary care slot in the country can be filled by md/do folks there will be an ongoing need for their services and this will be years into the next century if ever......
now crawl back into your basement, that's a good troll.......

 

[John_Doe]

http://www.aleyemd.com/press_releases/news_opt_surgery.html

Long article and I do not know the date of it, but interesting to note that this was written only a few years ago - and you can get a feel for the situation back then - now just a few years later, optometric laser can be done in all of US at any VAH, and OK optoms have moved from laser to non-laser surgery - what will it be like in a few years from now?.

 

[mdkurt]

wake up mac, pa's and np's are already working as pcp's and running small er's and have been for > 20 years in urban as well as rural areas. until every primary care slot in the country can be filled by md/do folks there will be an ongoing need for their services and this will be years into the next century if ever......
now crawl back into your basement, that's a good troll.......

Well...not really. PAs and NPs do fill a vital role taking some of the heat off MDs in these settings, but aren't running ERs by themselves. My father in law is an ER physician and managed a large group providing services to multiple ERs. He loved his PAs and valued their ability to take care of routine patients so his MDs didn't have to double-cover some shifts. They did, however, have a limit to their responsibilities and knowledge and required supervision. I don't think either party would have changed that.

 

[Andrew_Doan]

wake up mac, pa's and np's are already working as pcp's and running small er's and have been for > 20 years in urban as well as rural areas. until every primary care slot in the country can be filled by md/do folks there will be an ongoing need for their services and this will be years into the next century if ever......
now crawl back into your basement, that's a good troll.......

"emergency medicine p.a./instructor "

A clearly unbiased comment...

 

[deleted6669]

Dr doan, I was just trying to steer the discussion back to its original topic. macgyver can turn anything into a "let's bash on midlevels" discussion. and to the poster who doubts pa's run small solo er's: I am working a solo night shift right now in the er. I will post a few job ads for solo pa er gigs here later tonight if it is slow.
here's the first one of several I found. I can post more if anyone likes...
JOB # 313883
TITLE: Emergency Room PA
TAGLINE: Position available in Northern Michigan

LOCATION: Frankfort, Michigan FULL TIME/PART TIME: Full Time
CLIENT: Crystal Lake Emergency Services
PERMANENT/TEMPORARY: Permanent
POSTED: 8/17/2004 EMPLOYMENT/CONTRACT WORK: Employment
REPLY SENT: NO VISA WAIVER AVAILABLE: No


DESCRIPTION:
Immediate opening for a physician assistant to provide urgent/emergent care in a rural critical access hospital Emergency Room. This position requires at least one year of Emergency Room experience. The department is staffed with three physician assistants who work with on-call physician backup. Benefits include paid vacation, CME, life insurance, disability insurance, health insurance and 401(k) pension plan. Minimum salary: $70,500.

I am at work in a similar facility right now. "on call physician backup" means I call the doc in if we have a multicasualty incident and that's about it. in 3 years here they have never come in at night. I get consults from specialists as needed and admit pts as needed.I do occassional phone consults with my supervising md( maybe once a month) but for the most part call specialists directly for consults.my charts are reviewed the next day by the oncoming md(we staff md/pa during the day and solo pa at night). I see the full range of medical/trauma pts.

 

[Andrew_Doan]

Dr doan, I was just trying to steer the discussion back to its original topic. macgyver can turn anything into a "let's bash on midlevels" discussion. and to the poster who doubts pa's run small solo er's: I am working a solo night shift right now in the er. I will post a few job ads for solo pa er gigs here later tonight if it is slow.
here's the first one of several I found. I can post more if anyone likes...
JOB # 313883
TITLE: Emergency Room PA
TAGLINE: Position available in Northern Michigan

LOCATION: Frankfort, Michigan FULL TIME/PART TIME: Full Time
CLIENT: Crystal Lake Emergency Services
PERMANENT/TEMPORARY: Permanent
POSTED: 8/17/2004 EMPLOYMENT/CONTRACT WORK: Employment
REPLY SENT: NO VISA WAIVER AVAILABLE: No


DESCRIPTION:
Immediate opening for a physician assistant to provide urgent/emergent care in a rural critical access hospital Emergency Room. This position requires at least one year of Emergency Room experience. The department is staffed with three physician assistants who work with on-call physician backup. Benefits include paid vacation, CME, life insurance, disability insurance, health insurance and 401(k) pension plan. Minimum salary: $70,500.

I am at work in a similar facility right now. "on call physician backup" means I call the doc in if we have a multicasualty incident and that's about it. in 3 years here they have never come in at night. I get consults from specialists as needed and admit pts as needed.I do occassional phone consults with my supervising md( maybe once a month) but for the most part call specialists directly for consults.my charts are reviewed the next day by the oncoming md(we staff md/pa during the day and solo pa at night). I see the full range of medical/trauma pts.

Interesting post and thanks for the info. BTW, how much education and training is required to be a PA for the ER?

 

[deleted6669]

It varies quite a bit by location. for instance I have 2 bs degrees( medical anthropology and pa studies) and a masters level fellowship in emergency medicine (after 10 yrs in ems, most as a paramedic) - so my path took 9 years of schooling. some folks get an a.s. degree and a few years of urgent care under their belts and then get an er job. this option is being phased out as most pa programs are converting to ms level degrees by the end of the decade.many er positions are fast track only or double coverage with md's. the solo positions( maybe 5-10% of er pa jobs) generally require prior em experience( rn, emt-p, resp therapist).
this post may now return to its original topic without further interuption......

 

[Andrew_Doan]

this post may now return to its original topic without further interuption......

Perhaps this thread should be more appropriately titled: The Future of Medicine?

Ophthalmology is not unique in its battle against scope of practice expansion.

 

[John_Doe]

Academy and Puerto Rican Eye M.D.s Block Broadest O.D. Scope-of-Practice Legislation in the Country

August 26, 2004

WASHINGTON?The American Academy of Ophthalmology joined forces with the Puerto Rico Ophthalmological Society to derail the optometry lobby?s legislative effort to dramatically expand their optometric scope of practice. Ophthalmologists blocked legislation that would have allowed the broadest optometric scope of practice in the United States.

?If P.C. 4476 would have become law, Puerto Rico would have jumped from a jurisdiction with the most patient-friendly scope of practice to the broadest scope of practice in the U.S., including current laws in Oklahoma,? said Raul Franceschi, M.D., president of the Puerto Rico Ophthalmological Society. ?This bill would have been unprecedented, and our Eye M.D.s understood that they needed to act on behalf of patients.?

This is the latest in a growing number of national optometry-led assaults on patient safety. Since 1997, this effort in Puerto Rico was the 46th attempt in 21 states by organized optometry to legislate surgical privileges and the authority to perform injection procedures.

As introduced, P.C. 4476 would have allowed optometrists to prescribe any diagnostic, topical or oral drug and enable them to perform injection procedures. In addition, the bill could have provided a ?blank check? to the optometry board to authorize optometrists to perform any surgery, including laser or cataract surgery. No state allows optometrists such an unbridled scope of practice, and the Academy saw this as an aggressive assault on patient quality care and safety.

After passing the Puerto Rican House of Representatives, the bill was stopped in the Senate, thanks in part to the efforts of the Eye M.D.s to educate legislators on the patient risks associated with the bill.

?I hope every ophthalmologist takes note that we are battling optometry across the United States, and that their assaults on patient safety are not confined to specific state borders,? said Cynthia Bradford, M.D., Academy secretary for state affairs.

The Academy has helped defeat optometric scope of practice expansion legislation it considered detrimental to patient safety in five states this year.
----------------------------------------------
Why don't patients have some input any time optometry lobbies to increase their scope of practice - it seems like it is entirely PAC driven without regard to patient care - in my opinion one of the ironic things is that the people who vote yes to increasing the scope of practice of optoms, would in reality choose an ophthalmologist if they had an eye problem.

 

[vwhan]

...in my opinion one of the ironic things is that the people who vote yes to increasing the scope of practice of optoms, would in reality choose an ophthalmologist if they had an eye problem.

The question is does the general population know the difference between an optometrist and ophthalmologist?

 

[John_Doe]

Dr. G_ completed a residency in ocular disease and a fellowship in glaucoma and laser therapy at the Northeastern State University College of Optometry, where he remains on the adjunct faculty. He's a frequent author and lecturer in the areas of ocular disease, glaucoma and new technologies.

http://www.optometric.com/archive_results.asp?article=71119
-----------------------------------------

Any college grads out there want to become a glaucoma specialist and at the same time bypass the hassle and calls in medical school and residency - and avoid the MCATs and OKAPs ?

 

[John_Doe]

http://www.visioncareforums.com/showsubject.asp?MessageID=3239&siteid=om

Date Posted: 4/28/2004 1:53:50 AM | Opticians can refract in Canada Now!!!
A very disgusting bill has passed in the British columbia, Canada that allows Opticians use autorefractors to prescribe.

I have attached some recent information for those of you who are interested to see that this bill in BC can be the beginning of a much troubled future for our profession. I am deeply disgusted by how uninformed our politicians are to allow a bunch of technicians (i.e. Opticians) who only get two years of college education (not any university education) which is mosly focused on fitting glasses and bending frames to perform refraction. I have done years of research on design of autorefractors myself and know how notoriously inaccurate they inheretingly are. I have sent e-mails to the politicians in BC and urge all of you to do the same. I can guarantee you that if BC bill stays in effect, all 50 states and the rest of Canadian provinces will follow and allow Opticians refract. So, lets stop this before it gets out of hand. You can start by writing to the BC's minister of health, Colin Hansen: [email protected]

Some more background info:

Government to allow opticians to refract, here in North America! See the
> report's link at bottom
>
> Hello everyone:
>
> Please forward this to every OD you know!
>
> We need every OD to mobilize and leave a word or two to stop this from
> happening. Here's the email address to respond to, please help your
> colleagues in Canada by stopping this risky slippery slope in which we are
> about to embark: (Colin Hansen, Minister of Health)
> [email protected] As you may know, the government here in British
> Columbia has amended regulations governing the roles of it's opticians who
> now will be allowed to 'sight test' patients from 19 and 64 using
> computerized testing equipment after a simple consent form is signed. This
> of course, only further blurs the difference between a sight test and an eye
> health exam. This proposed change is expected to take effect following a
> three month consultation period. This proposal was generated by the
> Optician Association's reaction to proposed regulation amendments allowing
> OD's to diagnose and treat some eye diseases and disorders, and prescribe
> some therapeutic drugs. I moved here, like most of the other local OD's,
> from Oregon. We certainly have no shortage of qualified OD's. The mere
> proximity to P.U.C.O. entitles us to having the highest OD per person ratio
> in Canada, as well as most of the U.S. Therefore, any need in having
> Optician's refracting to assist in any backlog of patients is a preposterous
> notion. This is a very urgent call, we must pool every resource from OD's
> everywhere, this is a very serious precedent setting law. Once this is
> done, it will be impossible to reverse. So let me, or our association the
> British Columbia Association of Optometry, or BCAO, ' www.optometrists.bc.ca
> ' know if we can provide more details.
>
>
> I want to thank you for your support ahead of time, I can't begin to tell
> you how critical the situation is becoming. We've done everything possible
> at the local level, we now need all of our partners in Optometry to mobilize
> and email their thoughts of how disgusted they are, and what risk the public
> is in. If there is anything I can do to expedite this, just say the word,
> but I think at this point if everyone we know could simply say a few words
> to those in charge of health care here, (Colin Hansen, Minister of Health)
> [email protected]
> I'm sure he is not aware of the elicit corporate friendships between
> Opticianry and the government that are behind this irresponsible
> contemplation.
>
> Again the address is: [email protected]
> To read the report on optician's change of scope: http://www.gov.bc.ca/
>
http://www.opticians.ca/

 

[John_Doe]

http://www.optometric.com/archive_results.asp?article=71058&iss=5/1/04

Has there been any studies that looks at the general populations concept of an eye doctor, and if they know the differences between optom and ophthal, furthermore, who they would choose for their medical and surgical eye care - from the above article, the author implies that MD/residency is not even needed to become an full eye doctor with a medical/surgical capacity, and he also implies that the general public does not care if their complete eye care is provided by a non-physician - where is the data to support this? etc

 

[Visioncam]

I think that eventually optometrists will perform cataract surgery. Later they will perform retina surgery and oculoplastic surgery. They may even do breast augmentation.

In Oklahoma, they are allowed to do anything that the state optometry board allows. The new law prohibits anyone else from deciding or blocking it. They could even allow optometrist to do dog cataracts, something that ophthalmologists are prohibited from doing in most (but not all) states. The only hope is if the state optometry board also authorizes optometrists to practice law. If so, the lawyers will get upset and regulate the state optometry board.

As far as hoping that the optometrist will suffer complications and learn their lesson, this will not happen. The standard of care regarding complications will be lenient because optometry will be doing it for the first time. Therefore, any one optometrist would not be practicing below the standard of care even if they caused quite a few complications.

In some states, optometrist are allowed to call themselves "optometric physicians". The public knows that a "rug doctor" is just a carpet cleaning business and not a physician but they don't know that an optometric physician is not a physician.

 

[Visioncam]

I once saw some optometry students in their last year do a rotation. The preceptor joked to me that someone will pass out. Later he did an I&D of a chalazion in front of approximately 5-7 optometry students. Guess what? Thump. One of them passed out.

Jokes aside, the frightening thing about watching them one afternoon is seeing how little they know. They were 4th year optometry students, months away from taking care of patients. They knew much less than an ophthalmology resident. I know of a fairly sharp optometrist but I also have seen notes from several optometrists that are inaccurate and suggests that they didn't know what was going on.

The only possible reason that I would see an optometrist is if an ophthalmologist was impatient with refraction or possibly in fitting contact lenses. Some ophthalmology residents are not interested in working with contact lens patients.

 

[Mirror Form]

Even if optometrists begin to do surgery (god forbid), I think ophthalmology will still be a good field in the future. Any future optometrists who become "surgeons" will have their own best interests in mind. Therefore, they won't just flood the country with a huge number of optometrists who are trained to perform cataract surgery. They'll keep the numbers down so that business will still be good.

The real question is who will control the referalls. Do most referalls for cataract extractions come from optometrists or MD's?

 

[Andrew_Doan]

The real question is who will control the referalls. Do most referalls for cataract extractions come from optometrists or MD's?

Optometrists are the gate keepers.

 

[Richard_Hom]

Optometrists are the gate keepers.

Dr. Doan,

Could you elaborate on this concept?

 

[Andrew_Doan]

Dr. Doan,

Could you elaborate on this concept?

Because optometrists are primary eye care providers and outnumber ophthalmologists 3:1, optometrists are the major source of referrals for cataract surgery. Hence, this is why I used the term "gate keepers".

 

[Richard_Hom]

Because optometrists are primary eye care providers and outnumber ophthalmologists 3:1, optometrists are the major source of referrals for cataract surgery. Hence, this is why I used the term "gate keepers".

Dr. Doan,

Do you believe and "support" this notion that optometrists are "gate keepers" or are you simply explaining this concept?

 

[Andrew_Doan]

Dr. Doan,

Do you believe and "support" this notion that optometrists are "gate keepers" or are you simply explaining this concept?

I support it and define the concept.

 

[speyeder]

Academy and Puerto Rican Eye M.D.s Block Broadest O.D. Scope-of-Practice Legislation in the Country

August 26, 2004

WASHINGTON?The American Academy of Ophthalmology joined forces with the Puerto Rico Ophthalmological Society to derail the optometry lobby?s legislative effort to dramatically expand their optometric scope of practice. Ophthalmologists blocked legislation that would have allowed the broadest optometric scope of practice in the United States.

?If P.C. 4476 would have become law, Puerto Rico would have jumped from a jurisdiction with the most patient-friendly scope of practice to the broadest scope of practice in the U.S., including current laws in Oklahoma,? said Raul Franceschi, M.D., president of the Puerto Rico Ophthalmological Society. ?This bill would have been unprecedented, and our Eye M.D.s understood that they needed to act on behalf of patients.?

This is the latest in a growing number of national optometry-led assaults on patient safety. Since 1997, this effort in Puerto Rico was the 46th attempt in 21 states by organized optometry to legislate surgical privileges and the authority to perform injection procedures.

As introduced, P.C. 4476 would have allowed optometrists to prescribe any diagnostic, topical or oral drug and enable them to perform injection procedures. In addition, the bill could have provided a ?blank check? to the optometry board to authorize optometrists to perform any surgery, including laser or cataract surgery. No state allows optometrists such an unbridled scope of practice, and the Academy saw this as an aggressive assault on patient quality care and safety.

After passing the Puerto Rican House of Representatives, the bill was stopped in the Senate, thanks in part to the efforts of the Eye M.D.s to educate legislators on the patient risks associated with the bill.

?I hope every ophthalmologist takes note that we are battling optometry across the United States, and that their assaults on patient safety are not confined to specific state borders,? said Cynthia Bradford, M.D., Academy secretary for state affairs.

The Academy has helped defeat optometric scope of practice expansion legislation it considered detrimental to patient safety in five states this year.
----------------------------------------------
Why don't patients have some input any time optometry lobbies to increase their scope of practice - it seems like it is entirely PAC driven without regard to patient care - in my opinion one of the ironic things is that the people who vote yes to increasing the scope of practice of optoms, would in reality choose an ophthalmologist if they had an eye problem.

What's next? Should we start letting paralegals practice law? Using the rationale of those optometrists who want surgical rights, the answer would be yes.