How practical is it for a neurologist to practice ophthalmology?

[Gonio5]

How practical is it for a neurologist to practice ophthalmology in the office?

Some neuro-ophthalmologists did their training as a neurologist then did a neuro-ophthalmology fellowship. This is not too unusual.

What if a neurologist went even farther and practiced a mix of neuro-ophthalmology and office ophthalmology, like well controlled glaucoma, refraction, dry eye syndrome, etc. Perhaps someone with that training could be part of a practice of 2-3 ophthalmologists so that there would be backup in case of unfamiliar conditions?

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[Slide]

How practical is it for a neurologist to practice ophthalmology in the office?

Some neuro-ophthalmologists did their training as a neurologist then did a neuro-ophthalmology fellowship. This is not too unusual.

What if a neurologist went even farther and practiced a mix of neuro-ophthalmology and office ophthalmology, like well controlled glaucoma, refraction, dry eye syndrome, etc. Perhaps someone with that training could be part of a practice of 2-3 ophthalmologists so that there would be backup in case of unfamiliar conditions?

Not at all. If we ignore that there is no way this would ever fly per ACGME regulations or be considered by the ABOP or neurology equivalent, ophthalmology at its core is a surgical field, even though there is a lot of medical care. Even practicing bread and butter ophthalmology requires minimum 2 years of training because the skillset is completely different from neurology. How long did it take you to learn the slit lamp and indirect, including the time and exposure you get practicing as a medical student? Now imagine that for a neurology graduate who's never touched one. I do know a few physicians who were ophthalmologists in their native country and are now doing neurology, but they have given up ophthalmology completely.

If you've been on a neuro-ophthalmology rotation, you can understand why a dual pathway can exist. In terms of eye exam, the exam is extremely limited - EOM, pupils, optic nerve, which already have overlap in traditional neurology. From a general ophthalmology perspective, the neurology part is a bit more esoteric but can be learned in fellowship because the field is almost completely medical (save for a few places that might do neuro-strabismus cases). But it's really more an issue of need. There is such little interest and the field is desperate for applicants.

Even so, the liability with the set up of a neurologist seeing straightforward patients with an ophthalmologist backing up doesn't make any sense. From a business standpoint, it wouldn't make much sense either - the whole point of having a neuro-ophthalmologist is for most ppl to offload neuro-ophth issues to them so they can focus on the less time consuming issues that really pays the bills, not have them help see the easy patients. It makes more sense to hire an optometrist to help with those issues if anything (which is exactly what they are meant to do).

 

[TheLesPaul]

If you haven't gone through a surgical residency, you cannot practice ophthalmology.

 

[Gonio5]

If you haven't gone through a surgical residency, you cannot practice ophthalmology.

Mostly true but I've seen internists and family medicine try to treat patients with eye conditions.

A neurologist doing neuro-ophthalmology could probably see a few general ophthalmology patients. Insurance claims would be paid. However, if the patient sued, the neurologist would be held to the same standard as an ophthalmologist if they tried to treat ophthalmology patients. Therefore, I believe that neuro-ophthalmologists who trained as neurologists generally won't want to see patients with general ophthalmology problems.

 

[TheLesPaul]

Mostly true but I've seen internists and family medicine try to treat patients with eye conditions.

A neurologist doing neuro-ophthalmology could probably see a few general ophthalmology patients. Insurance claims would be paid. However, if the patient sued, the neurologist would be held to the same standard as an ophthalmologist if they tried to treat ophthalmology patients. Therefore, I believe that neuro-ophthalmologists who trained as neurologists generally won't want to see patients with general ophthalmology problems.

I think you misunderstand me. Any nonsurgical physician can "try to treat patients", but for many of the common ophthalmologic conditions, definitive treatment is surgical. Unless you learn surgery, you will not be able to know when these treatments are indicated or be able to perform them in a timely fashion. You might end up hanging on to "well-controlled glaucoma" patients for years without the proper interventions, like some optometrists do. It's like playing basketball with one hand tied behind your back. You'll never be as good. Why would you want to do that? Enjoy your own specialty.