HR 5688 - “Healthcare Truth and Transparency Act"

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ProZackMI,

I know you are also a Lawyer, so i was just wondering if maybe you can shed some light on what this bill will actually do, because I am not really clear on that fact.

Would this bill stop Optometrist (or anybody else who is not a MD, DO, or DDS) from using the term "Dr."... or will it just require Optometrists to state that they are Optometrists or Doctors of Optometry?

I personally have big problems with the first... :eek: but absolutely no problems with the second one.

So.... what will this bill really do?

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ProZackMI said:
No. Optometrists are NOT ophthalmologists, so why would they be held to that standard of care?

I've read several of your posts on this forum and generally like your objectivity. I do however disagree with the above comment. I'm no lawyer, but it's my understanding that OD's are held to the exact same standard as ophthalmologists. If I see an ocular condition then it's my obligation to treat that condition to the accepted standard, not some "optometric" standard. If it is beyond my scope then I must make appropriate refferal. If I misdiagnose any eye disease that results in harm to the patient, I am screwed, as is any other "doctor". If your PCP unwittingly treats your psuedomonal ulcer with steroids, and you go on and perforate, your PCP is screwed. If you treat ANY health condition, then you must be held to the accepted standards for that condition, not some fictitious standard based on the type of medicine you practice.

Also, I would'nt harp too much on OD's that are "misrepresenting themselves" I've never seen anything that would constitute this behavior, and I know I've witnessed more everday OD practice then most on this ophthalmology forum.
If you want to talk about misleading the public perhaps we should be dicussing the treatment of eye conditions by non-ophthalmic MD's, or nurses, PA's, or other types of healthcare workers, who's collective training regarding the eye, amounts to so much as a fart in a hurricane. Now that's a bill to be put before the legislature, hell I'm sure us OD's could drum up some data (because it actually exists) about the dangers posed to the public by non-opth or non-opts treating the eye as if they knew what they were doing.
 
PBEA said:
I've read several of your posts on this forum and generally like your objectivity. I do however disagree with the above comment. I'm no lawyer, but it's my understanding that OD's are held to the exact same standard as ophthalmologists. If I see an ocular condition then it's my obligation to treat that condition to the accepted standard, not some "optometric" standard. If it is beyond my scope then I must make appropriate refferal. If I misdiagnose any eye disease that results in harm to the patient, I am screwed, as is any other "doctor".
There is no optometry standard vs. ophthalmology standard. Ocular conditions have a standard of care. If that standard of care is beyond what an OD can legally do, then the patient has to be referred to an MD.
 
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Hines302 said:
ProZackMI,

I know you are also a Lawyer, so i was just wondering if maybe you can shed some light on what this bill will actually do, because I am not really clear on that fact.

Would this bill stop Optometrist (or anybody else who is not a MD, DO, or DDS) from using the term "Dr."... or will it just require Optometrists to state that they are Optometrists or Doctors of Optometry?

I personally have big problems with the first... :eek: but absolutely no problems with the second one.

So.... what will this bill really do?

Dr. Hines,

The problem with Bill, in its current proposed form, is that it is laden with ambiguities and vagueness. I'll elaborate, but essentially, to answer your question, it will require any non-physician (or dentist???) health care provider to over-qualify or over-state the fact that they are not an MD, DO, or DDS. In other words, you can use the term "Dr.", but you'll always have to incorporate the term optometrist or O.D. or "Doctor of Optometry.”

If the Bill passes, optometrists will NOT be allowed to do the following:

1. Advertise as “eye doctors”; refer to themselves as “eye doctors” or allow their staff to refer to them as “eye doctors”;
2. Answer the phone “Dr. Smith’s office” without qualifying that Smith is an OD;
3. use the term “Dr.” as a prefix without appending “O.D.” or “Optometrist” after the name
4. Advertise specialized training like residencies as this could potentially cause patients to believe that such training was equivalent to a medical residency
5. Perform surgical care; post-op care, etc.;

Another thing the Bill will do is prevent optometrists, chiropractors, vets, psychologists, and others from creating websites or brochures that say things like “MEET OUR DOCTORS” or “OUR DOCTORS”. The Bill would also prevent office staff from saying things like “The Doctor will see you now, Mr. Jones.” Your brochures and biographies would have to say something like “MEET OUR PROFESSIONAL STAFF” or “MEET OUR OPTOMETRISTS”. Staff would have to say “Dr. Smith will see you now, Mr. Jones,” but not, “The Doctor will see you now.”

Also, in brochures and on websites, you couldn’t use words or terms that would cause patients to assume you’re a physician by virtue of the services you’re offering or your training. Things like specialized optometric residencies and fellowships could be construed as medical residencies, so this might “mislead” a patient into thinking you have equivalent training to an MD.

Essentially, the primary problem the Bill is proposing to address is ambiguity in the usage of the term “doctor” AND “misleading/deceptive advertising.” When the common American on the street hears the term “doctor”, he/she thinks of a physician, not a pharmacist, lawyer, dentist, geneticist, anthropologist, or optometrist. Many health care providers use the term “doctor” without explaining what kind. This Bill will force all professionals to include their degrees or state their profession. It would also force providers to be precise with words. Rather than the generic “doctor”, you’d be referred to as “optometrist” or “doctor of optometry”.

The Bill will never pass as the language is too vague and ambiguous and it does not clearly define terms. What exactly is “equivalent”? If I’m an OD and have done a one-year residency and a three-year post-doc fellowship, wouldn’t I have the same length of training as an MD with a four-year residency? If I have specialized training, but don’t use words like residency, am I still being misleading when describing my credentials?

Also, the Bill does not explain why a dentist is afforded protection, but a podiatrist, who often performs surgery, is not. I don’t think there are too many folks out there posing as dentists, or deliberately trying to cause others to assume they are dentists.

Another problem is that the average American is a *****. Sorry, but it’s true. There are many honest health care providers out there who NEVER try to fool their patients, but how many blue-collar folks who only graduated from high school really know the difference between an MD, OD, PHD, PharmD, DDS, DVM, or JD? How many Wal-Mart folks know the difference between a BA and an MBA? This Bill is designed with good intentions and aims to protect folks from underqualified quacks passing themselves off as physicians, but in reality, it will do little to protect consumers because the average consumer has the IQ of a peanut shell and simply wouldn’t understand the difference even if clearly spelled out in black-and-white.

So, that's my take on it. Is this what you got from it too?
Zack
 
Ben Chudner said:
There is no optometry standard vs. ophthalmology standard. Ocular conditions have a standard of care. If that standard of care is beyond what an OD can legally do, then the patient has to be referred to an MD.


Thats what I just said? Prozack seemed to intimate otherwise.
 
PBEA said:
I've read several of your posts on this forum and generally like your objectivity. I do however disagree with the above comment. I'm no lawyer, but it's my understanding that OD's are held to the exact same standard as ophthalmologists. If I see an ocular condition then it's my obligation to treat that condition to the accepted standard, not some "optometric" standard. If it is beyond my scope then I must make appropriate refferal. If I misdiagnose any eye disease that results in harm to the patient, I am screwed, as is any other "doctor". If your PCP unwittingly treats your psuedomonal ulcer with steroids, and you go on and perforate, your PCP is screwed. If you treat ANY health condition, then you must be held to the accepted standards for that condition, not some fictitious standard based on the type of medicine you practice.

Also, I would'nt harp too much on OD's that are "misrepresenting themselves" I've never seen anything that would constitute this behavior, and I know I've witnessed more everday OD practice then most on this ophthalmology forum.
If you want to talk about misleading the public perhaps we should be dicussing the treatment of eye conditions by non-ophthalmic MD's, or nurses, PA's, or other types of healthcare workers, who's collective training regarding the eye, amounts to so much as a fart in a hurricane. Now that's a bill to be put before the legislature, hell I'm sure us OD's could drum up some data (because it actually exists) about the dangers posed to the public by non-opth or non-opts treating the eye as if they knew what they were doing.


Medical malpractice, and optometric malpractice being a form of med-mal, falls under the tort law principle of negligence. Negligence is basically defined as:

1. A duty one has to another (in this case, provider to patient);
2. There has been a breach of that duty (unintentionally);
3. That breach has either directly or proximately caused
4. The defendant harm (usually physical, but can be mental); and
5. The defendant can be compensated through damages (a monetary compensation to make the defendant whole again).

A health care provider is held to a standard of care of reasonably prudent health care providers in the national economy, who possess similar training, expertise, and skill. This standard of care is defined by your profession. If most optometrists perform Exam A with Instrument X, but Defendant performs Exam A with Instrument Y, he has breached his standard of care as a reasonably prudent optometrist with similar training to other reasonably prudent optometrists.

So, there is a standard of care for optometrists that is defined by the practice, custom, training, and scope of practice of optometry in general. An OD is NOT held to a physician's standard of care due to the fact that an MD has different training, expertise, and skills. However, if a procedure can be performed by an OD, MD (IM/GP), or OMD, than an OD can be held to the same standard of care as the others if that procedure can be performed by all them without specialized training.

A physician is held to a general medical standard of care and then to a standard of care common to a particular specialty. An NP is held to an NP standard of care, unless the NP is acting in a similar fashion to a physician.

Basically, yes, this is quite confusing, but the key to the analysis is in the facts. Who did what, when, and how? The facts determine the duty, the standard of care applied, and the degree of causation. If an OD and an OMD perform the same job functions, their standard of care will be similar.
 
Ben Chudner said:
There is no optometry standard vs. ophthalmology standard. Ocular conditions have a standard of care. If that standard of care is beyond what an OD can legally do, then the patient has to be referred to an MD.

No. There is a standard of care of all professionals. The duty you have to refer outside your area of knowledge/competence, or scope of practice, is but one aspect of the standard of care. I'm not talking about exceeding your scope of competence or training. I'm talking about the standard of care you are held when doing your job under normal circumstances. Everyone makes mistakes. If you are inserting a contact lense and scratch someone's cornea, are you going to be held to the same standard as an ophthalmologist or optician? Maybe. However, most likely, you'll be held to the standard of other ODs.

If you are taking a PHx and accidentally mark aphakic instead of phakic, and it ends up harming the patient somehow, you're going to be held to the standard of care exercised by most prudent ODs, not most surgeons or IMs.

The key is in the facts. In some cases, there is a general standard of care shared among all professionals who are permitted, by virtue of training, law, and experience, to perform a particular procedure. For example, if you're a medical OD in OK and you've been performing laser surgeries (LASIK?) for four years, and you accidentally injure your patient, you will be held to the standard of care of OMDs, not ODs, since most ODs don't perform that type of surgery. If general surgeons also perform LASIK, ODs, MDs, and OMDs will all be held to the same standard. If NPs can also perform LASIK, well...you get the picture.
 
ProZ.,

I am curious about this bill. If it does pass, I wonder what the reactions of the various state legislatures would be. I handle a lot of U.S.C. cases that are filed in the state courts and until recently, there was no state law and very few state court opinions re: the fed. law. Often the FCC, FTC, etc. have opt in/out clauses. I didn't see it in the proposed bill. I'm willing to bet that a few states would opt out and/or reject through their own laws this bill if it passes. What do you think?
 
ProZackMI said:
No. There is a standard of care of all professionals. The duty you have to refer outside your area of knowledge/competence, or scope of practice, is but one aspect of the standard of care. I'm not talking about exceeding your scope of competence or training. I'm talking about the standard of care you are held when doing your job under normal circumstances. Everyone makes mistakes. If you are inserting a contact lense and scratch someone's cornea, are you going to be held to the same standard as an ophthalmologist or optician? Maybe. However, most likely, you'll be held to the standard of other ODs.

If you are taking a PHx and accidentally mark aphakic instead of phakic, and it ends up harming the patient somehow, you're going to be held to the standard of care exercised by most prudent ODs, not most surgeons or IMs.

The key is in the facts. In some cases, there is a general standard of care shared among all professionals who are permitted, by virtue of training, law, and experience, to perform a particular procedure. For example, if you're a medical OD in OK and you've been performing laser surgeries (LASIK?) for four years, and you accidentally injure your patient, you will be held to the standard of care of OMDs, not ODs, since most ODs don't perform that type of surgery. If general surgeons also perform LASIK, ODs, MDs, and OMDs will all be held to the same standard. If NPs can also perform LASIK, well...you get the picture.
Your CL example makes sense, but let's be honest here. The lawsuits are going to result from much bigger damages. For example, the Florida OD that missed the 4x4x4 choroidal melanoma. He had not dilated the patient for several years and missed it. The standard of care for this patient is the same for both OD's and MD's. He should have dilated the patient. This is the "general standard of care shared among all professionals who are permitted, by virtue of training, law, and experience, to perform a particular procedure" that you mention above. I think our point was that for ocular disease diagnosis and management, the standard of care we will be held to is the same as the MD's. For the more trivial stuff like managing a CL patient, I would agree we would be most likely held to same standards as other OD's.
 
ProZackMI said:
Medical malpractice, and optometric malpractice being a form of med-mal, falls under the tort law principle of negligence. Negligence is basically defined as:

1. A duty one has to another (in this case, provider to patient);
2. There has been a breach of that duty (unintentionally);
3. That breach has either directly or proximately caused
4. The defendant harm (usually physical, but can be mental); and
5. The defendant can be compensated through damages (a monetary compensation to make the defendant whole again).

A health care provider is held to a standard of care of reasonably prudent health care providers in the national economy, who possess similar training, expertise, and skill. This standard of care is defined by your profession. If most optometrists perform Exam A with Instrument X, but Defendant performs Exam A with Instrument Y, he has breached his standard of care as a reasonably prudent optometrist with similar training to other reasonably prudent optometrists.

So, there is a standard of care for optometrists that is defined by the practice, custom, training, and scope of practice of optometry in general. An OD is NOT held to a physician's standard of care due to the fact that an MD has different training, expertise, and skills. However, if a procedure can be performed by an OD, MD (IM/GP), or OMD, than an OD can be held to the same standard of care as the others if that procedure can be performed by all them without specialized training.

A physician is held to a general medical standard of care and then to a standard of care common to a particular specialty. An NP is held to an NP standard of care, unless the NP is acting in a similar fashion to a physician.

Basically, yes, this is quite confusing, but the key to the analysis is in the facts. Who did what, when, and how? The facts determine the duty, the standard of care applied, and the degree of causation. If an OD and an OMD perform the same job functions, their standard of care will be similar.

Holy legalese, Batman!! Now I remember why I did'nt even consider a law degree as an option. Nice reply Prozack, my face hit the table right after the first paragraph. Thanks alot.:laugh: :laugh: :laugh:
 
Ben Chudner said:
Your CL example makes sense, but let's be honest here. The lawsuits are going to result from much bigger damages. For example, the Florida OD that missed the 4x4x4 choroidal melanoma. He had not dilated the patient for several years and missed it. The standard of care for this patient is the same for both OD's and MD's. He should have dilated the patient. This is the "general standard of care shared among all professionals who are permitted, by virtue of training, law, and experience, to perform a particular procedure" that you mention above. I think our point was that for ocular disease diagnosis and management, the standard of care we will be held to is the same as the MD's. For the more trivial stuff like managing a CL patient, I would agree we would be most likely held to same standards as other OD's.

Basically, it boils down to what you (the OD) is doing and if it something that is medical or optometric. If it's something than can be construed as both (like a general eye exam, retinal dilation, glaucoma test, etc.), then you might be held to the standard of care of all vision specialists or ocular health care practitioners (of which, an MD internist would be excluded, but an OD would be included).

If an OD missed a choroidal melanoma by forgetting to dilate the patient for several years, he still may not be held to the same standard as an OMD. It would depend on the pt's hx. If he's a diabetic or has a hx of mac degeneration, or something similar, where frequent dilation is part of the general exam process given the dx, then yes, I'd say that OD is negligent. However, if that OD has no reason to dilate, per se, why perform a procedure like that every year? I'm not an OMD, so I really don't know how often or frequent you'd dilate a generic patient, without a hx of ocular path, when doing a basic vision exam.

So, if you're an OD, and you have no reason to suspect your patient would have a melanoma, and you don't dilate, chances are you may not be held to the same standard as an OMD. After all, if I'm seeing an OMD, there is a strong chance I have a medical reason for being there, thus dilation would be a routine procedure to rule out things lke proliferative retinopathy, mac degeneration, etc. However, if I'm seeing an OD, for basic eye care, and have no h/o ocular disease, a routine annual dilation may not be standard procedure.

In my case, I have no h/o ocular disease and I see an OD yearly for a basic eye exam and new glasses. She's only dilated me once in the last few years. I honestly don't know if she should be doing it, but if she failed to miss something like a melanoma on exam, I'm not sure she would be held to a different standard as other ODs in her situation.
 
ProZackMI said:
Also, the Bill does not explain why a dentist is afforded protection, but a podiatrist, who often performs surgery, is not. I don’t think there are too many folks out there posing as dentists, or deliberately trying to cause others to assume they are dentists.

Zack

this is the biggest problem i have with it. dentists are just as much a non-physician as a podiatrist or optometrist. why are they excluded?
 
drgregory said:
this is the biggest problem i have with it. dentists are just as much a non-physician as a podiatrist or optometrist. why are they excluded?


Dentists don't really overlap with physicians except those oral-maxillary dentist surgeons. Podiatrists and optometrists overlap considerably more, and since ODs are trying to do LASIK, get operating rights, and other stuff, it helps to create barriers. It's just a rightful lashing back for the OK thing. You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!
 
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m3unsure said:
Dentists don't really overlap with physicians except those oral-maxillary dentist surgeons. Podiatrists and optometrists overlap considerably more, and since ODs are trying to do LASIK, get operating rights, and other stuff, it helps to create barriers. It's just a rightful lashing back for the OK thing. You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!

Sigh

As has been stated before, most DPM work is stuff that orthos don't want to fool with (ie. diabetic foot day in and day out).

Likewise, MOST ODs have no interest in surgery. Its actually becoming a fairly big rift between most ODs and their political action groups. Currently, most ODs care more about a national level of care, inclusion into medical insurance, and commercial optometry. Surgery is far down on that list, for those ODs that even care.

What ODs do want is the ability to practice to their training. Yes, that does include some pathology. And it doesn't have to overlap with MDs. ODs are great gateway eye providers. Otherwise, every patient with red eyes would go straight to them. And sure, some of that would be interesting stuff.... but lots of it wouldn't be (read: allergic conjunctivitis).
 
m3unsure said:
Dentists don't really overlap with physicians except those oral-maxillary dentist surgeons. Podiatrists and optometrists overlap considerably more, and since ODs are trying to do LASIK, get operating rights, and other stuff, it helps to create barriers. It's just a rightful lashing back for the OK thing. You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!

calm down and re-read my post. i actually stated that ODs, DDSs, and DPMs are all very non-physician. i was only questioning why DDSs were not included in the act. so the arguement that because we overlap more than dentists has no grounds for us being not called "doctors of optometry". dentists should have to clarify as well that they are not MDs.

please work on your reading comprehension. you just argued against me saying that optometry is a very non-physician profession.
 
m3unsure said:
Dentists don't really overlap with physicians except those oral-maxillary dentist surgeons. Podiatrists and optometrists overlap considerably more, and since ODs are trying to do LASIK, get operating rights, and other stuff, it helps to create barriers. It's just a rightful lashing back for the OK thing. You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!

Man, I thought I had a big mouth!? Your argument is whiney gibberish. You must still be an MS3 right? And your possibly interested in ophthalmology, right? Let me ask you something, does your rhetoric come from your professors in medical school, or from the doctors on your rotations, or is it both? I ask because medical students seem to be well versed in the political aspects of scope of practice issues (when they know little else), and was wondering if you maybe get classtime devoted to these "important" topics. Please note heavy sarcasm.
 
m3unsure said:
Dentists don't really overlap with physicians except those oral-maxillary dentist surgeons. Podiatrists and optometrists overlap considerably more, and since ODs are trying to do LASIK, get operating rights, and other stuff, it helps to create barriers. It's just a rightful lashing back for the OK thing. You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!


Actually, um, a DDS is a Doctor of Dental SURGERY. A DMD = Doctor of Dental MEDICINE. Even general dentists perform invasive medical procedures routinely, whereas ODs do not. The origins of dentistry lie in medicine, not education and opticianry like optometry. Maybe I'm not stating this correctly, but optometry does not originate from medicine; it has different origins, whereas dentistry has always been a companion of medicine. Dentistry has much more overlap with medicine than optometry does. Optometrists don't perform surgery and most likely never will (except in OK). Not all pods do surgery, but many do. Guess what? Those that do must go through a 2-4 year residency. A MEDICAL/SURGICAL residency on par with allo/osteo residencies -- not a year-long post OD CL residency or something like that. Sorry, I don't mean to offend, but it's true. OMFS also undergo extensive PGY training, 4-5 years I believe.

As a general rule, dental school is very similar to medical school in that the basic clinical sciences are integrated into a systemic medical approach. I don't really know much about OD training, but based on comments from a few folks on the forum, it seems like ODs don't receive a comprehensive medical education and therefore lack a systemic understanding of pathophys. Example, your patient might present with a recalcitrant, persistent cough. Without a comprehensive training in systemic medicine, a practitioner might first assume it's a respiratory problem (i.e., URI, asthmatic bronchitis, pneumonia), but in reality, it could be cardiac (cor pulmonale, congestive heart failure, cardiomegaly), digestive (gastroesphageal reflux disease), muscular (hernia, diaphragm problems), infectious (viral, allergic), neoplastic, and possibly, neurogenic/psychogenic.

The purpose of this Bill is not to punish ODs, but to curtail non-physician health care providers from inducing uninformed patients into thinking they are physicians, quasi-physicians, or have skills on par with physicians. Optometrists, for the most part, simply do their job and don't mess with people like that. However, take a look at some chiropractors who have ads in the phone book. What do you see? You see chiros wearing stethoscopes. You see an overempahsis on titles like DOCTOR and chiropractic PHYSICIAN. You see this a lot with naturopaths also. To a lesser extent, you see some abuses with mental health professionals who have doctorates in things like English, education, higher ed admin, etc, but master's in SW or psych and limited licenses. They use that doctoral title and create false percecptions with their patients/clients. That is what the Bill is designed to stop, not you guys who, for the most part, do your job competently and professionally.

HOWEVER, that being said, many OMDs and MDs in general, and some lawmakers and citizens out there, don't like your quest for professional expansion. You might continue to grow professionally, but I don't see ODs ever gaining complete RxPs or surgical authority or hospital privileges. In most states, ODs can only serve as hospital staff (like nurses, pharmacists, lab techs, etc.), not attending staff (like MDs, DOs, PhDs, dentists, and pods).

And, no, I'm not in support of the Bill and I don't think it's going to affect professionals who act responsibly and honestly.
 
drgregory said:
this is the biggest problem i have with it. dentists are just as much a non-physician as a podiatrist or optometrist. why are they excluded?

except for dentists and pods can prescribe meds to an extent that an opt. cannot. except for the fact that dentists and pods have cutting instruments that they, by law, can use, and an opt. does/cannot. in many states, pods are named in legal documents as podiatric physicians, who can treat ANY ailment of the foot and in many cases, ankles. the bottom line is that opt.s have big brothers=opthamologists. pods do not, nor do GENERAL dentists, whom i have witnessed many times perform "oral surgery". scopes differ within subspecialties, but gen dents and pods are much different than opts.
just like prozack says, these areas (dental/pod) have medical lineage, where opt. does not.
 
so the key thing ODs should push for is the renaming of our degree!

who cares where anybody's profession's originates from? what matters is what they can do now and the training they recieve now. by playing the history card, PhD will immediately trademark the title "doctor" and send the rest of us scrambling for a new title. ODs have the term optometrist so we are safe!

in all seriousness, ODs spend TOO MUCH Time being jealous of dentistry and the DAMN OMDs that are seeking to destroy us, along with the cursed commericial ODs that make tons of money but make private practioners (that term is not claimed by MDs right ?) look unprofessional. What optometrists needs to do is seek to be proactive and fix things internally instead of spending all our time blaming outside factors. since many talk about improvement but dont offer specific suggestions i will take a stab (bear in mind i am first year and know very little!)

1) OMDs dont trust our training? FIX OUR CIRRICULUM. Make it as comprehensive as medical school and invite professors to rate the material and offer thier criticisms. Make it so our training leaves no doubt to (reasonable) OMDs that our education is not for some second rate refraction monkey. Worried that ODs cant take the training required to treat pathology? why should OMds who also treat ocular pathology want to be partners with those with inferior training? show them!

2) Want less oversupply? We can look fondly on how dentistry solved it all day. How about we do something about it? Many websites (cough cough Odwire) are BEGGING for current ODs that care to being grassroot campaigns to get the schools to listen. Dont think that will work? start your own idea! even just talking as an alumni to your old professors (or current) about ideas or concerns is a good start. Dont want to do anything about it? then just complain online and be miserable!

3) worried that we will lose our "doctor" title? see number 1 and shut the OMDs up.

4) want surgery? go to medical school! OR at the very least seek to find a way to gain residency (no unfair or circumventing plan) to opth programs. just trying to do surgery without any approval training by surgeons is unacceptalbe (take heed OK!)

5) want less commericalization see 1) and 2) as well as actively bring attention to illegal independent contracters.

This bill is unfair in some ways, long overdue in others, but I see it as a chance to move optometry forward. we have come so far and have overcome so much to reach where we are today. We have fought the laws and the OMDs. I think its time we fought to fix ourselves. The grass is always greener on the other side and ODs have concentrated on the negative aspects of the profession, which is great, it gives us time to reflect and fix it!
 
ProZackMI said:
Actually, um, a DDS is a Doctor of Dental SURGERY. A DMD = Doctor of Dental MEDICINE. Even general dentists perform invasive medical procedures routinely, whereas ODs do not. The origins of dentistry lie in medicine, not education and opticianry like optometry. Maybe I'm not stating this correctly, but optometry does not originate from medicine; it has different origins, whereas dentistry has always been a companion of medicine. Dentistry has much more overlap with medicine than optometry does. Optometrists don't perform surgery and most likely never will (except in OK). Not all pods do surgery, but many do. Guess what? Those that do must go through a 2-4 year residency. A MEDICAL/SURGICAL residency on par with allo/osteo residencies -- not a year-long post OD CL residency or something like that. Sorry, I don't mean to offend, but it's true. OMFS also undergo extensive PGY training, 4-5 years I believe.

I agree, I've often harped on the origins of optometry/ophthalomolgy myself, and have often stated that it is surprising to me that these fields do not educate along a similiar tract. However, origin isn't the issue, current training is more relevent, and future training is ultimately what should be discussed.

As a general rule, dental school is very similar to medical school in that the basic clinical sciences are integrated into a systemic medical approach. I don't really know much about OD training, but based on comments from a few folks on the forum, it seems like ODs don't receive a comprehensive medical education and therefore lack a systemic understanding of pathophys. Example, your patient might present with a recalcitrant, persistent cough. Without a comprehensive training in systemic medicine, a practitioner might first assume it's a respiratory problem (i.e., URI, asthmatic bronchitis, pneumonia), but in reality, it could be cardiac (cor pulmonale, congestive heart failure, cardiomegaly), digestive (gastroesphageal reflux disease), muscular (hernia, diaphragm problems), infectious (viral, allergic), neoplastic, and possibly, neurogenic/psychogenic.

OD school does not prepare us to deal with any of the above conditions. You think dental school does? Maybe as it relates to the oral cavity, but I'm sure it does'nt go much beyond that (DDS students help me out). That sounds alot like OD school, systemic conditions as it relates to the eye, and only the eye. You are mistaken if ANY OD alive (or dentist) would presume to comment on a systemic condition, unless is was causing sequlea in the eye. I think the analogy comparing dentistry to optometry is more accurate then you think, at least in practice it does.

The purpose of this Bill is not to punish ODs, but to curtail non-physician health care providers from inducing uninformed patients into thinking they are physicians, quasi-physicians, or have skills on par with physicians. Optometrists, for the most part, simply do their job and don't mess with people like that. However, take a look at some chiropractors who have ads in the phone book. What do you see? You see chiros wearing stethoscopes. You see an overempahsis on titles like DOCTOR and chiropractic PHYSICIAN. You see this a lot with naturopaths also. To a lesser extent, you see some abuses with mental health professionals who have doctorates in things like English, education, higher ed admin, etc, but master's in SW or psych and limited licenses. They use that doctoral title and create false percecptions with their patients/clients. That is what the Bill is designed to stop, not you guys who, for the most part, do your job competently and professionally.

HOWEVER, that being said, many OMDs and MDs in general, and some lawmakers and citizens out there, don't like your quest for professional expansion. You might continue to grow professionally, but I don't see ODs ever gaining complete RxPs or surgical authority or hospital privileges. In most states, ODs can only serve as hospital staff (like nurses, pharmacists, lab techs, etc.), not attending staff (like MDs, DOs, PhDs, dentists, and pods).

You bash citizen IQ in one post, and then list them as credible critic of OD skill in another? PhD's, did you mean MD, PhD's? Dentist? I have a friend, he's the only OMFS I know, he says not to consider dentists as any different then OD's, OMFS=ophthalmogy, dentistry=optometry, his analogy, not mine.. Your objectivity is lost here. I really don't see any downside to providing more widespread, competent eyecare (given a proper supply/demand ratio). There is a huge double standard in eyecare services. One: a competent OD provides complete, competent primary eyecare, and gets bashed because "you don't think I should be doing it". Two: Any garden-variety MD, PA, nurse, tech can launch any Rx they want at the poor unsuspecting eye patient, and, when the shoot hits the fan, have it deemed "within the standard of care", by the people from legal. What a friggin' crock!! Yet, OD's spend four years in focus on eyecare, we are second to none in ~95% of delivered ophthalmic care. That's one hell of a critical eye you got there, way to use the overwhelming burden of evidence. Logic?? what's that you say? do the math, I say! Did someone mention evidenced-based medicine? I'm to the point where I don't care what "many OMDs and MDs in general have to say about this, and some lawmakers and citizens out there" As far as I'm concerned, you don't know what the fudge you are talking about, and need to be TOLD WHAT TO DO!!! I would'nt trust your simple visual acuity notation, let alone your ability to assess my skill and training. The only other joe that speaks OD, is OMD, and he's too busy trying to keep a good man down.

And, no, I'm not in support of the Bill and I don't think it's going to affect professionals who act responsibly and honestly.

Thank heavens for that
 
still_confused said:
so the key thing ODs should push for is the renaming of our degree!

who cares where anybody's profession's originates from? what matters is what they can do now and the training they recieve now. by playing the history card, PhD will immediately trademark the title "doctor" and send the rest of us scrambling for a new title. ODs have the term optometrist so we are safe!

in all seriousness, ODs spend TOO MUCH Time being jealous of dentistry and the DAMN OMDs that are seeking to destroy us, along with the cursed commericial ODs that make tons of money but make private practioners (that term is not claimed by MDs right ?) look unprofessional. What optometrists needs to do is seek to be proactive and fix things internally instead of spending all our time blaming outside factors. since many talk about improvement but dont offer specific suggestions i will take a stab (bear in mind i am first year and know very little!)

1) OMDs dont trust our training? FIX OUR CIRRICULUM. Make it as comprehensive as medical school and invite professors to rate the material and offer thier criticisms. Make it so our training leaves no doubt to (reasonable) OMDs that our education is not for some second rate refraction monkey. Worried that ODs cant take the training required to treat pathology? why should OMds who also treat ocular pathology want to be partners with those with inferior training? show them!

2) Want less oversupply? We can look fondly on how dentistry solved it all day. How about we do something about it? Many websites (cough cough Odwire) are BEGGING for current ODs that care to being grassroot campaigns to get the schools to listen. Dont think that will work? start your own idea! even just talking as an alumni to your old professors (or current) about ideas or concerns is a good start. Dont want to do anything about it? then just complain online and be miserable!

3) worried that we will lose our "doctor" title? see number 1 and shut the OMDs up.

4) want surgery? go to medical school! OR at the very least seek to find a way to gain residency (no unfair or circumventing plan) to opth programs. just trying to do surgery without any approval training by surgeons is unacceptalbe (take heed OK!)

5) want less commericalization see 1) and 2) as well as actively bring attention to illegal independent contracters.

This bill is unfair in some ways, long overdue in others, but I see it as a chance to move optometry forward. we have come so far and have overcome so much to reach where we are today. We have fought the laws and the OMDs. I think its time we fought to fix ourselves. The grass is always greener on the other side and ODs have concentrated on the negative aspects of the profession, which is great, it gives us time to reflect and fix it!

As a 1yr OD student, you show remarkable insight! It seems that medical school is not the only place to receive an education in "scope of practice 101". I'm tired and won't respond to each talking point you list, though they are well stated. I'll just propose my solutions. It is my feeling that 1 of 2 things should occur. 1) ophthalmology should absorb optometry (optometrists go to medical school, no more OD degree). or 2) optometry should evolve to include additional residencies for various subspecialties including any and all ocular surgery (no more ophthalmologists, just ophthalmic specialists) All of the above does USMLE, board cert, etc. A proper supply/demand ratio of practitioners exists. You can say goodbye to declining RVU's for ophthalmic service/surgery under those circumstances, justifiably so.
 
m3unsure said:
You want to steal ophthalmology's role blatantly with your supposedly superior education and knowledge even though people getting into OD schools are on average not nearly as bright as a top notch AOA ophthalmology resident. Don't expect to climb to the top while stepping on someone else's back!
What the hell are you talking about? No one has ever said that our education is superior. Furthermore, your statement above regarding OD students on average in comparison to a top notch AOA ophthalmology resident is the lamest thing I have ever read. I could also say that the people getting into medical school are on average not nearly as bright as a top notch AOA ophthalmology resident. It would have the same meaning....absolutely nothing. Heck, the people getting into medical school on average are not as bright as a top notch BSK optometry resident. If you want to attack OD's, go back the the ophthalmology forum where that kind of talk is tolerated.
 
PBEA said:
. . . however, origin isn't the issue, current training is more relevent, and future training is ultimately what should be discussed.

I was just saying that I believe dentistry is often more aligned with medicine, for better or for worse, logically or illogically, is due to its common origin with medicine. I also think that because dentists do "oral surgery", even if limited, it is considered more medical/surgical than optometry, which is often considered to be refractive rather than medical. Also, I hate to say it, but the commerical ODs make others think of...well...retail not clinical practice. Sorry. :(

No disrepect intended.

OD school does not prepare us to deal with any of the above conditions. You think dental school does? Maybe as it relates to the oral cavity, but I'm sure it does'nt go much beyond that

I went to med school at Michigan State, so there were no dental students here, but I knew a few dental students at UMich and UDetroit and from what I heard, of course this is hearsay and not direct evidence, they actually learned quite a lot of MEDICINE (not just dental med) in dental school. One of the posters (maybe Dr Gregory) mentioned something about ODs not working up to their full training. I think maybe dentists learn a great deal of systemic medicine unrelated to dentistry due to the fact that they have unfettered RxPs and perform "surgery" (kinda sorta). I mean, some dental prophylaxis and/or tx can cause pericarditis or endocarditis, so they have to know some basic cardio, facial neurology, oseology, and probably some vascular stuff. But, you might be right. I really don't know directly what a DDS knows. I was speculating. You're right about the analogy between OD and DDS.

You bash citizen IQ in one post, and then list them as credible critic of OD skill in another? PhD's, did you mean MD, PhD's? Dentist? I have a friend, he's the only OMFS I know, he says not to consider dentists as any different then OD's, OMFS=ophthalmogy, dentistry=optometry, his analogy, not mine..

My comment was "...many OMDs and MDs in general, and some lawmakers and citizens out there, don't like your quest for professional expansion." The "some" qualifies and quantifies both lawmakers and citizens. I never said I was one of these citizens, did I? I never said I was siding with them, did I? I merely stated that there are some folks out there, both degreed and undegreed (is that a word?) who feel threatened by optometry's medical expansion, at least here in the US. You can bet the AMA and American Ophthalmology Ass'n is fueling this movement.

Heh, in general, I have little respect for the IQ of the average American. They did, in theory, vote for W...twice.

No, I meant PhDs. Medical staff, with full or partial hospital privileges, in many states, typically include allo/osteo physicians (of all specialties), podiatrists, OMFS and a few oral surgeons, and clinical doctoral psychologists. I've been on credentialling committees at two different hospitals where the issue of hosp. privis came up for general dentists, optometrists, chiropractors, audiologists, and clinical pharmacists. Each time it was determined that chiros, optos, and audios had no business seeing patients at the hospital. However, there were two PharmDs who were given full privileges in the anticoagulation clinic. PAs have no privis, but NPs have special status along with CRNAs. At Beaumont, we had one OD (Dr. Woods) who was a low vision specialist who worked at the Low vision clinic, but has HOSPITAL staff. He had no privis. That's how it was at U of M and a few other hospitals too.

I know things are different at the VA and in other states. However, from what I understand, in MOST states, ODs have no attending privis, but in many states, PsyD/PhD psychologists do. Afterall, many of them are actually treating patients on a long-term basis just like psychiatrists.

Your objectivity is lost here. I really don't see any downside to providing more widespread, competent eyecare (given a proper supply/demand ratio). There is a huge double standard in eyecare services. One: a competent OD provides complete, competent primary eyecare, and gets bashed because "you don't think I should be doing it". Two: Any garden-variety MD, PA, nurse, tech can launch any Rx they want at the poor unsuspecting eye patient, and, when the shoot hits the fan, have it deemed "within the standard of care", by the people from legal. What a friggin' crock!! Yet, OD's spend four years in focus on eyecare, we are second to none in ~95% of delivered ophthalmic care. That's one hell of a critical eye you got there, way to use the overwhelming burden of evidence. Logic?? what's that you say? do the math, I say! Did someone mention evidenced-based medicine? I'm to the point where I don't care what "many OMDs and MDs in general have to say about this, and some lawmakers and citizens out there" As far as I'm concerned, you don't know what the fudge you are talking about, and need to be TOLD WHAT TO DO!!! I would'nt trust your simple visual acuity notation, let alone your ability to assess my skill and training. The only other joe that speaks OD, is OMD, and he's too busy trying to keep a good man down.

Wow. :( I hope you weren't directing that at me. I apologize if I offended you. I guess I should just keep my mouth shut. I think ODs have the training and potential to do a lot more than they do. I believe that with some modification of the status quo, ODs can fill an important niche in the health care arena. You keep blaming the OMDs who are too buys "trying to keep a good man down", but why not point that fine-tuned perception inward and examine your own profession? Optometry strives to be more, but it seems to me that there are still many issues that keep your profession back. Curriculum? Commercialism in the profession? Lack of public awareness? I don't know, but it's got to be something. Rather than point fingers, what can you, as an OD, do to make your profession more respected? What can you do to make it better for young ODs graduating from school? Is lobbying enough? Is public education enough? Do you want full prescriptive authority? Do you want to expand into surgery and surgical care?

Optometry defines optometry. The question is, who is speaking on optometry's behalf? Someone as passionate as you? Or some old dude working at Lenscrafters? Dr. Chudner or Dr. Hom, or some atrophied refractor at Wal-mart? Part of the problem is lack of unity in your own profession. Do you see this divide in ophthalmology?

Peace,
Zack
 
ProZackMI said:
Actually, um, a DDS is a Doctor of Dental SURGERY. A DMD = Doctor of Dental MEDICINE.
As a general rule, dental school is very similar to medical school in that the basic clinical sciences are integrated into a systemic medical approach. I don't really know much about OD training, but based on comments from a few folks on the forum, it seems like ODs don't receive a comprehensive medical education and therefore lack a systemic understanding of pathophys. Example, your patient might present with a recalcitrant, persistent cough. Without a comprehensive training in systemic medicine, a practitioner might first assume it's a respiratory problem (i.e., URI, asthmatic bronchitis, pneumonia), but in reality, it could be cardiac (cor pulmonale, congestive heart failure, cardiomegaly), digestive (gastroesphageal reflux disease), muscular (hernia, diaphragm problems), infectious (viral, allergic), neoplastic, and possibly, neurogenic/psychogenic.

The purpose of this Bill is not to punish ODs, but to curtail non-physician health care providers from inducing uninformed patients into thinking they are physicians, quasi-physicians, or have skills on par with physicians. Optometrists, for the most part, simply do their job and don't mess with people like that. However, take a look at some chiropractors who have ads in the phone book. What do you see? You see chiros wearing stethoscopes. You see an overempahsis on titles like DOCTOR and chiropractic PHYSICIAN. You see this a lot with naturopaths also. To a lesser extent, you see some abuses with mental health professionals who have doctorates in things like English, education, higher ed admin, etc, but master's in SW or psych and limited licenses. They use that doctoral title and create false percecptions with their patients/clients. That is what the Bill is designed to stop, not you guys who, for the most part, do your job competently and professionally.

HOWEVER, that being said, many OMDs and MDs in general, and some lawmakers and citizens out there, don't like your quest for professional expansion. You might continue to grow professionally, but I don't see ODs ever gaining complete RxPs or surgical authority or hospital privileges. In most states, ODs can only serve as hospital staff (like nurses, pharmacists, lab techs, etc.), not attending staff (like MDs, DOs, PhDs, dentists, and pods).

And, no, I'm not in support of the Bill and I don't think it's going to affect professionals who act responsibly and honestly.


I just wanted to point out that at UAB we take practically all of our basic systemic science courses (ie. Histology, Physiology, General Pathology, Systemic Path, Gen. Pharm, Microbiology, Immunology, etc.. etc... ) with the dental students. Certainly our education in the basic sciences is not any different than theirs if we are in the same class. I am sure if we are taught this and expected to know information, it is presented at the other OD schools as well, we all take the same boards after all. The parameters of OD practice will no doubt continue to change.

I can assure you that we learn a lot of crap that we will likely never use again, but some of it is quite important. If dental students learn “medicine” then we do too. That is what angers me the most, seeing dentistry as being presented as somehow on par with medicine and some how we are not, when I sat next to dental students in all of those basic science classes (if they even bothered to show up) .
 
UABopt said:
I just wanted to point out that at UAB we take practically all of our basic systemic science courses (ie. Histology, Physiology, General Pathology, Systemic Path, Gen. Pharm, Microbiology, Immunology, etc.. etc... ) with the dental students. Certainly our education in the basic sciences is not any different than theirs if we are in the same class. I am sure if we are taught this and expected to know information, it is presented at the other OD schools as well, we all take the same boards after all. The parameters of OD practice will no doubt continue to change.

I can assure you that we learn a lot of crap that we will likely never use again, but some of it is quite important. If dental students learn “medicine” then we do too. That is what angers me the most, seeing dentistry as being presented as somehow on par with medicine and some how we are not, when I sat next to dental students in all of those basic science classes (if they even bothered to show up) .

I believe Dentists are on par with medicine, because they are the highest level of education involving the teeth. In comparison, Ophthalmologists have the highest education regarding the eye. Therefore, both being experts in their respective fields, they are viewed as comparative.
 
I Surgeon said:
I believe Dentists are on par with medicine, because they are the highest level of education involving the teeth. In comparison, Ophthalmologists have the highest education regarding the eye. Therefore, both being experts in their respective fields, they are viewed as comparative.
I'm not trying to start anything this time, but wouldn't an OMFS residency be the highest level of education involving the teeth? Obviously there are problems with this type of compairson due to the fact that a DDS can go on and complete an OMFS residency and an OD cannot go on and complete an ophthalmology residency.
 
lillytwig said:
just like prozack says, these areas (dental/pod) have medical lineage, where opt. does not.

i always thought some of the first dentists were barber shop owner (no offense). the first optometry roots came from jewelry shops. both are pretty non-medical, unless im mistaken on the roots of each.
 
ProZackMI said:
Also, I hate to say it, but the commerical ODs make others think of...well...retail not clinical practice. Sorry. :(
Optometry defines optometry. The question is, who is speaking on optometry's behalf? Someone as passionate as you? Or some old dude working at Lenscrafters? Dr. Chudner or Dr. Hom, or some atrophied refractor at Wal-mart? Part of the problem is lack of unity in your own profession. Do you see this divide in ophthalmology?

Peace,
Zack

this is the core problem. our training is exacto with dentistry, yet we ourselves are the problem. commercialism, cowboy ODs, and lack of residency like dentists have. we should be on par with dentists, pods, and psychDs, but piss down our leg and work at wally world, and unsuspecting general population views us as technicians. someone said to abolish optometry - i agree that merging it with ophthalmology would be the best thing - give residency opportunities to current ODs, and if they cannot hack the residency, make non-residency trained ODs scope of practice limited, and the new residency trained ODs scope on par with OMDs, and in the mean time graduate no more ODs - all eye care in 30 years would be MD eye care.
 
Ben Chudner said:
I'm not trying to start anything this time, but wouldn't an OMFS residency be the highest level of education involving the teeth? Obviously there are problems with this type of compairson due to the fact that a DDS can go on and complete an OMFS residency and an OD cannot go on and complete an ophthalmology residency.

I see your point, but that would mean that any dentist with a year or two of residency could only be on par with a doctor. which would be the highest level of education--orthodontics, pediatrics, OMFS? I don't know.

You are right OD cannot go on to do a medical specialty, because it is medical specialty and there are plenty of qualified medical applicants. OMFS is a Dental residency. They believe they are dentists before they are doctors, because they are. I see no need for OD to be able to do an ophthalmology residency. It is competitive enough for a MD to get into residency and we definately don't need a surplus of eye surgeons. We already have enough surgeons and have many qualified medical school seniors applying for these positions.
 
I Surgeon said:
You are right OD cannot go on to do a medical specialty, because it is medical specialty and there are plenty of qualified medical applicants.
Do you really feel the need to bold the word medical as you state the obvious? Are you trying to be antagonistic? I have never said that an OD should be able to go on and do a medical specialty.
OMFS is a Dental residency. They believe they are dentists before they are doctors, because they are.
If you are implying that OD's see themselves as doctors first and optometrists second, you have no idea what you are talking about. Our opposition to this bill is not because we see ourselves as the same level of provider as OMD's.
I see no need for OD to be able to do an ophthalmology residency. It is competitive enough for a MD to get into residency and we definately don't need a surplus of eye surgeons. We already have enough surgeons and have many qualified medical school seniors applying for these positions.
I agree completely with you. I am not one that believes the answer to this problem is to allow OD's to complete an OMD type residency.
 
If you are implying that OD's see themselves as doctors first and optometrists second, you have no idea what you are talking about.


I never said that nor believe such. I think we agree for the most part. :)
 
I have a question: Does anybody understand why some people have issues with optometrists calling themselves "Eye Doctors"?

This seriously bugs me. The degree conferred upon an optometrist is granted through a four year doctorate-level program with the option for additional residency specialization, and the primary focus (no pun intended) of all of this professional education is on eye care. Hence: "Eye Doctor."

Now, I hear-tell there's this one medical specialization called "ophthalmology"...apparently it's what people do when they want to perform eye surgery. So, shouldn't these people be called "Eye Surgeons"? If this bill goes through, shouldn't it only help the relationship between OD's and OMD's? As I understand it, OD's are the primary eye care physicians/doctors/specialists/whatevertitlefloatsyourego'sboat who refer patients to the OMD surgeons when needed.

So, the question is...would you go to an orthodontist to get your teeth cleaned? They can give you braces if you happen to need them..."total oral care"...it'd be fully covered by your insurance. Why then, would someone want to go to an eye surgeon for their general eye exam? Can anybody explain to me what in the optical world specifically causes this "overlap" that isn't seen in Dentistry? I just don't understand it yet.
 
WoodyJI said:
I have a question: Does anybody understand why some people have issues with optometrists calling themselves "Eye Doctors"?

This seriously bugs me. The degree conferred upon an optometrist is granted through a four year doctorate-level program with the option for additional residency specialization, and the primary focus (no pun intended) of all of this professional education is on eye care. Hence: "Eye Doctor."

Now, I hear-tell there's this one medical specialization called "ophthalmology"...apparently it's what people do when they want to perform eye surgery. So, shouldn't these people be called "Eye Surgeons"? If this bill goes through, shouldn't it only help the relationship between OD's and OMD's? As I understand it, OD's are the primary eye care physicians/doctors/specialists/whatevertitlefloatsyourego'sboat who refer patients to the OMD surgeons when needed.

So, the question is...would you go to an orthodontist to get your teeth cleaned? They can give you braces if you happen to need them..."total oral care"...it'd be fully covered by your insurance. Why then, would someone want to go to an eye surgeon for their general eye exam? Can anybody explain to me what in the optical world specifically causes this "overlap" that isn't seen in Dentistry? I just don't understand it yet.


AN OD IS NOT A PHYSICIAN! GET IT THROUGH YOUR HEAD! You are an optometrist, plain and simple. NOT A PHYSICIAN! This Bill is designed to keep people like you from misleading the public. You apparently want people to assume you're an "eye doctor" or PCP, when you're an optometrist. Your example about orthodontics is simplistic and irrelevant.

I'm not trying to denigrate optometry, but you are not a physician. Until the primary purpose of optometry is to be a PCP for the eyes, which current optometry is NOT, then you're not primary care providers.

Why can't you be called "eye doctor"? You can be, but you should refer to yourself as optometrist. Why? To say "I'm an eye doctor" rather than optometrist is playing on the "doctor" part, which the average idiot out there believes to be a physician.

Do you say, "I'm going to see my law doctor about a Will" or "I'm taking my cat to the animal doctor" or "I'm going to see my tooth doctor" today. NO! You say lawyer, vet, or dentist. So, why should optometrists be eye "doctors" rather than what they are, optometrists?
 
WoodyJI said:
Can anybody explain to me what in the optical world specifically causes this "overlap" that isn't seen in Dentistry? I just don't understand it yet.

explained: oversupply of ODs and eyeMDs (part of which is worsened by corporate optometry); undersupply of dental/dental specialty and therefore appropriate fee level for service.

lessen the amount of ODs and eyeMDs, and get rid of corporate optometry. fee levels for service begin to be set at levels appropriate for primary eye care and surgical eye care, and suddenly ODs and eyeMDs get along.
 
It’s just so sad to see how people took the original post and turned it totally around. Are you guys jealous? Don't try to intimidate us, we would not be. Speaking from personal experience, most optometrist say they are an eye doctor because most of our public do not even know how to pronounce "Optometrist" or know what it means. Btw, optometrist do get a doctorate degree and there is no law that says they are not "EYE doctors" which also does not mean they do surgery. Why don't you all haters get it through your head instead of teaching us and leave us alone!

I am sorry if I sound insulting but many users have forced me to write this way.
I kindly request the moderator of SDN to take an action or close this thread. Thank you for understanding!
 
sweetzpassion said:
It’s just so sad to see how people took the original post and turned it totally around. Are you guys jealous? Don't try to intimidate us, we would not be. Speaking from personal experience, most optometrist say they are an eye doctor because most of our public do not even know how to pronounce "Optometrist" or know what it means. Btw, optometrist do get a doctorate degree and there is no law that says they are not "EYE doctors" which also does not mean they do surgery. Why don't you all haters get it through your head instead of teaching us and leave us alone!

I am sorry if I sound insulting but many users have forced me to write this way.
I kindly request the moderator of SDN to take an action or close this thread. Thank you for understanding!

Jealous? Intimidate you? You are obviously a very misinformed person. You're also only a pre-opt student, so what personal experience do you have?

I think all people who hold a doctorate should start using the title like you optometrists do:.

Vets: animal doctors
dentists: tooth doctors
lawyers: law doctors
pods: foot doctors
psychologists: mental doctors
literature profs: book doctors
sociologists: social doctors
pharmacist: pill doctors
audiologists: ear doctors

You know, most people have no problem with optometrist, psychiatrist, psychologist, veterinarians, orthodontists, gynecologists, podiatrist, etc. Orthodontist is more cumbersome than optometrist, yet you don't see them referred to as "braces doctor" or even dentists, do you? People like you are going to fuel the fire for that Bill to get approved.
 
ProZackMI said:
AN OD IS NOT A PHYSICIAN! GET IT THROUGH YOUR HEAD! You are an optometrist, plain and simple. NOT A PHYSICIAN! This Bill is designed to keep people like you from misleading the public. You apparently want people to assume you're an "eye doctor" or PCP, when you're an optometrist. Your example about orthodontics is simplistic and irrelevant.

WE ARE NOT CLAIMING TO BE PHYSICIANS! GET IT THROUGH YOUR HEAD! NOR DO WE MISLEAD THE PUBLIC. We do assume the title of eye doctor because that's what we are, you just don't have the knowledge or ability to comprehend this fact. The orthodontic argument is simple, relevent, and accurate.

I'm not trying to denigrate optometry, but you are not a physician. Until the primary purpose of optometry is to be a PCP for the eyes, which current optometry is NOT, then you're not primary care providers.

This whole paragraph is horse____. You would'nt be on this forum if you weren't trying to let us know how you feel about optometry. We are exactly primary eyecare providers, nothing less. Who else would be the "PCP for the eyes"? You seem to think you, or any other non-ophth MD, knows as much or more then an OD regarding medical eyecare. You could not be futher from the truth, and clearly are unable to police your own profession (MD), let alone mine.

Why can't you be called "eye doctor"? You can be, but you should refer to yourself as optometrist. Why? To say "I'm an eye doctor" rather than optometrist is playing on the "doctor" part, which the average idiot out there believes to be a physician.

Do you say, "I'm going to see my law doctor about a Will" or "I'm taking my cat to the animal doctor" or "I'm going to see my tooth doctor" today. NO! You say lawyer, vet, or dentist. So, why should optometrists be eye "doctors" rather than what they are, optometrists?

That's great, you want to play petty semantics, you go ahead. If MD's want sole possession of the term doctor, then they can have it. But then NO ONE else gets to use it, not dentist, vet, OD, PhD, etc, etc. Further more, if this stupid bill passes, then I propose that the OD (and OMD's?) get together and pass a law LIMITING ANY AND ALL EYE DIAGNOSIS AND TREATMENTS, TO THOSE THAT RECIEVE ADEQUATE TRAINING IN THIS FIELD OF MEDICINE, NAMLEY OD's AND OMD's, NO ONE ELSE. We'll call it the "Tranparency in Eyecare Bill", and that would be a bill that would fly through the legislature like greased lighting, you know why? Because it would be sooo simple to show how people like you (non-ophth,non-OD) really know nothing about eyecare.
 
To ProZackMI:
Hahaha, you make me laugh! I think you need to treat and educate yourself then educating others. May be you should start taking prozac yourself, because you seem to be going through major dperession.

To fellow optometrists, just ignore this member!
 
sweetzpassion said:
To ProZackMI:
Hahaha, you make me laugh! I think you need to treat and educate yourself then educating others. May be you should start taking prozac yourself, because you seem to be going through major dperession.

To fellow optometrists, just ignore this member!

I admire your passion and fire... but you aren't helping our cause. ProZack is a very educated member of SDN. Go through and read some of his past posts, and you will see that he usually presents a fairly unbiased opinion. He does have some past posts that were somewhat negative towards optometry, but we've all seemed to make up since then.

If you don't like his arguments, present specific reasons, backed up with facts, why you believe he is wrong... but don't attack him personally. Hopefully everyone will afford you the same respect.
 
prettygreeneyes said:
I admire your passion and fire... but you aren't helping our cause. ProZack is a very educated member of SDN. Go through and read some of his past posts, and you will see that he usually presents a fairly unbiased opinion. He does have some past posts that were somewhat negative towards optometry, but we've all seemed to make up since then.

If you don't like his arguments, present specific reasons, backed up with facts, why you believe he is wrong... but don't attack him personally. Hopefully everyone will afford you the same respect.

i agree. ProZack usually presents unbiased, factual points. he has some older posts that are somewhat negative towards optometry, but i think he has taken the time to learn what we do. he is beginning to realize (or already has) that optometry's desire is to hold similar professional standing to denists, only in the realm of eye care. he also understands that this will never happen as we ourselves are the biggest obstacle; corporate optometry.
 
ProZackMI said:
Until the primary purpose of optometry is to be a PCP for the eyes, which current optometry is NOT, then you're not primary care providers.
How is the primary purpose of an OD NOT primary eye care? I got the impression that all of the optometrists in private practice that I shadowed last year basically were PCP's for the eyes. They saw their patients regularly, had a good doctor-patient relationship, and helped them manage their diabetes, glaucoma, etc. They didn't just fit them with a lens prescriptions and then boot them out the door. Maybe that happens in corporate optometry sometimes, but that's not an optometrist's primary purpose. Optometrist can prescribe oral and topical medications-not just lenses. Isn't prescription power usually the thing that separates a doctor from any other health care professional in the minds of the public?

I don't understand why someone who goes to optometry school for 4 years to learn systemic anatomy alongside everything else, graduates with the ability to manage ocular disease and everything under the sun related to eye-health (besides surgery, of course) would have to argue semantics with people who went to medical school for 4 years, and then decided that they wanted to work on people's eyes instead of their lungs, brains or colons. Optometrists go into school knowing what they want to do, OK? Do you really think that people people with GPA's and test scores demonstrating them perfectly capable of doing med school would choose optometry if all we did was refract? The entering class at OSU Optometry School this year has a GPA range averaging out at 3.5 and extending up to a 4.0. The OSU med school's average GPA is a 3.6...you win, do you want a cookie? If pre-optometry students wanted to do surgery they'd go to med school, but they wouldn't go through optometry school + optional residency specialization for their primary purpose NOT to be a PCP for the eyes. I'll call myself a "Primary Care Practitioner" if it'll help you sleep better at night. What I won't do is cause a patient to doubt unnecessarily the quality of the care I'll provide simply because optometry school is separate and more focused on eye care than medical school is, and therefore I can't technically (according to the literal definition of the word) call my self a Physician. The patients I see are still going to respect me as such--that is, unless you can "inform" them differently. This is an ego thing, and you need to drop it because the point is that optometrists are not misleading the public when they say that they're primary care eye doctors. They didn't go to medical school, yes, but that doesn't mean they don't give the best primary eye care a patient can receive.
 
I appreciate that you all are responding to my post. How can you say that our dear educated memeber prozackmi has learned or learning about optometry, when he doesn't even know about the very basics of optometry.
 
WoodyJI said:
How is the primary purpose of an OD NOT primary eye care? I got the impression that all of the optometrists in private practice that I shadowed last year basically were PCP's for the eyes. They saw their patients regularly, had a good doctor-patient relationship, and helped them manage their diabetes, glaucoma, etc. They didn't just fit them with a lens prescriptions and then boot them out the door. Maybe that happens in corporate optometry sometimes, but that's not an optometrist's primary purpose. Optometrist can prescribe oral and topical medications-not just lenses. Isn't prescription power usually the thing that separates a doctor from any other health care professional in the minds of the public?

I don't understand why someone who goes to optometry school for 4 years to learn systemic anatomy alongside everything else, graduates with the ability to manage ocular disease and everything under the sun related to eye-health (besides surgery, of course) would have to argue semantics with people who went to medical school for 4 years, and then decided that they wanted to work on people's eyes instead of their lungs, brains or colons. Optometrists go into school knowing what they want to do, OK? Do you really think that people people with GPA's and test scores demonstrating them perfectly capable of doing med school would choose optometry if all we did was refract? The entering class at OSU Optometry School this year has a GPA range averaging out at 3.5 and extending up to a 4.0. The OSU med school's average GPA is a 3.6...you win, do you want a cookie? If pre-optometry students wanted to do surgery they'd go to med school, but they wouldn't go through optometry school + optional residency specialization for their primary purpose NOT to be a PCP for the eyes. I'll call myself a "Primary Care Practitioner" if it'll help you sleep better at night. What I won't do is cause a patient to doubt unnecessarily the quality of the care I'll provide simply because optometry school is separate and more focused on eye care than medical school is, and therefore I can't technically (according to the literal definition of the word) call my self a Physician. The patients I see are still going to respect me as such--that is, unless you can "inform" them differently. This is an ego thing, and you need to drop it because the point is that optometrists are not misleading the public when they say that they're primary care eye doctors. They didn't go to medical school, yes, but that doesn't mean they don't give the best primary eye care a patient can receive.

I absolutely agree! Eye doctors, eye physicians as long as you make sure to acknowledge the "eye" in the title, what is the problem? Plus being a primary eye care provider can mean optometrist can sometimes be the first one to spot issues like diabetes, high blood pressure etc...even before their primary care physician. :eek:

Heck, some people don't even go to their family doctor regularly(maybe a fear of doctors, lack of insurance, etc), but if they are having trouble seeing, then they are more likely to go to their local optometrist...and in the exam might be able to spot trouble.
 
sweetzpassion said:
I appreciate that you all are responding to my post. How can you say that our dear educated memeber prozackmi has learned or learning about optometry, when he doesn't even know about the very basics of optometry.

You're right, because Dr. Gregory (a practicing OD who has debated with ProZack) would have no idea what he does or doesn't know.

I'll admit that in the past I've had a few heated debates with Zack, but even in those he was rational and unbiased. You can't ask for much more than that.
 
wanted to make a points generally rather than specifically.

First, I am NOT trying to attack optometry. I am not a "hater" of optometry as that one misguided pre-optometry student said. I do not support a Bill that would preclude you from using an earned title (i.e., "doctor"). If you have read any of my posts, you'd see that. In addition, I fully admit that I'm an MD with training in internal med and psychiatry only. I'm NOT an ophthalmologist. Other than treating basic allergic or infectious conjunctivitis, I have absolutely NO experience in treating ocular pathology. Also, I fully admit that I have never been to optometry school and don't know what receiving an OD degree requires.

Second, I have nothing against optometry. Optometrists are well-educated professionals who serve a very vital and important role in health care. MANY (I don't know how many, but MANY) children, adolescents, and adults require some form of corrective lenses. Without these lenses, many of us with poor eyesight couldn't perform our jobs or operate a motor vehicle. I have worn glasses since I was 12 and I'm 35 years-old now. A LONG TIME. Optometrists examine eyes, prescribe lenses, and now, provide a full range of visual health services. I never disputed that. Over the last year or so, many posters on the OD forum have taught me a great deal about how much your profession has evolved and what optometry school actually entails. Prior to this epiphany, I admit, I assumed you were glorified techs who had inflated degrees with little or no medical training.

The ODs I've seen, throughout my life, have worked mostly retail/commerical and did not seem very medical to me. I remember during med school, I needed new glasses, and saw my regular optometrist who was asking me about school. I was talking about a woman who had a CVA and some residual hemiparesis and the optometrist said "What's a CVA?" This guy, however, insisted on being called DOCTOR and never let his patients/clients forget that. Things like that stuck in my craw and helped form my opinion that optometrists were non-medical quasi-professionals who loved the title "doctor". Many MD/DO colleagues shared my sentiment.

This forum has helped change my views and I have learned that I was very wrong. That does not change the fact that I have some valid concerns about optometry, which I have shared here. Specifically, my concern is regarding the language of this proposed Bill, taking us back to the topic.

Many of you were concerned that this Bill might pass and would therefore somehow hinder your quest for expanded scopes of practice or would set the practice of optometry back. Many of you erroneously assumed that if the Bill passed, it would limit your use of the title "doctor", etc. I read the language of the Bill and posted comments that I do not believe it will ever pass because it is way too ambiguous and vague. There are terms that are not clearly defined and there are obvious politically-motivated groups fueling the Bill (e.g., the AMA and ADA).

Why does this Bill exist in the first place? Does the big-bad-old AMA wanna hurt optometrists? NO. This Bill is only partially focused on optometry. What it really is geared for is ANY health care professional who INTENTIONALLY, DELIBERATELY, or NEGLIGENTLY induces the public (a barely literate public that is already incredibly naieve and uninformed) into thinking that he/she is a physician or possess training equivalent to a physician.

Using the title "doctor" is only a small portion of what the Bill would limit. However, remember one thing, UNLESS your state has a specific law that limits the title "doctor" to specific uses, ANYONE who holds an earned doctorate, either academic or professional, is allowed to use that title in any capacity he/she chooses. In most states, practitioners must qualifiy and clarify what kind of doctors they are (e.g., "Doctor of Optometry" or "O.D." versus "eye doctor"). Here, in MI, optometrists must advertise with O.D or "Doctor of Optometry" or "optometrist". In ads and on signs, they cannot use "eye doctor", by law. In common language, they can use "eye doctor", but this Bill would make that practice illegal as that usage would induce the public into thinking that "eye doctor" = MD/DO. Why? The public is comprised, by and large, of mostly uneducated, lazy people who don't know the difference and assume every "doctor" is an MD.

You shouldn't be so hung up on the title anyway. You can still be "Bob" and do your job effectively even if the Bill were to preclude you from using "doctor", which it won't. It's amazing how petty some people are when confronted with losing some "prestige".

This Bill is primarily aimed at chiros and naturopaths who are egregious in their deceptive practices. I've seen ads for chiros who are wearing white coats and stethoscopes. WTF? A chiro? Chiros love their "doctor" title and often use it without appending "D.C." or "Doctor of Chiropractic". Many chiros use chiropractic physician other terms like "sports medicine", "physical med and rehab specialist", "team physician", etc. Many naturopaths use the term physician and over-emphasize the title "doctor".

Where do ODs fall into this? The terms "eye doctor" and "optometric physician" ARE misleading, ambiguous, or deceptive. You may not think so, but in reality, no matter how good your schooling is, an OD is not a physician under most state medical practice statutes. Unless you want the liability of a "physician", and therefore, the malpractice insurance of one, be thankful you're not and don't use that term. Don't go around saying "eye doctor". Be specific and honest -- what's wrong with optometrist? Most patients are stupid, but even the dumb ones understand an orthodontist means braces and an optometrist means glasses/eyes.

Also, don't go outside your realm of knowledge or your scope of practice. PBEA went out of his way to explain how I, as an internist/psychiatrist, am an idiot when it comes to ocular dx and tx. At least I went to medical school and understand systemic medicine, not just ocular med/path. Increased IOP might be indicative of glaucoma or something else. ODs are not trained to read MRIs and CTs. You guys don't know how to read MRAs. You don't really know much about evoked potentials. You know what you know and know it well but there is MUCH more to practicing medicine as a PCP than what you know.

You went to school for 4 years to be an optometrist. Some of you did, or will do, a ONE year post OD "residency" (which is not a 24/7 on-call, in a hospital, working ALL floors residency). Physicians went to med school for 4 years (and by the way, this only gives us a medical education; we don't learn how to be doctors in med school, we learn how to be doctors in residency by rotating in OB-GYN, neuro, psych, path, emergency med, etc.) and then went through a 3-7 year residency learning our craft. We see hundreds of patients and rotate through a myriad of specialties learning the subtleties and nuances of diagnosis, treatment, appropriate pharmacological tx, diagnostic testing, radiology, test interpretation, patient-counseling, etc.

In 4 years, you learn how to be primary care optometrists, not physicians. There is simply no way your training is adequate or comprehensive enough to qualify you as a physician. I'm sorry to tell you this, but it's true. How many of you have had to go out into a waiting room and tell some parents their teenage son's suicide attempt was successful this time around? How many of you have ever had to tell someone they were dying or somone they loved had died?

That does not mean an OD is inferior to an MD. Far from it. You're just different. There is nothing wrong that. However, if you're proud of who you are and what you do, why compare yourself to dentists and doctors? Why not just be happy that you're an OD and do your job the best you can? This Bill won't pass, so don't worry about it. However, if you're honest and specific with your language, it shouldn't apply to you.

Peace,
Zack
 
sweetzpassion said:
To ProZackMI:
Hahaha, you make me laugh! I think you need to treat and educate yourself then educating others. May be you should start taking prozac yourself, because you seem to be going through major dperession.

To fellow optometrists, just ignore this member!

It's really sad that you have to resort an ad hominem type of attack, kid. Also, since it's unlikely you're a psychiatrist, clinical psychologist, licensed professional counselor, or licensed clinical social worker, it's illegal for you to diagnose a disorder like major depression.

At least I made you laugh :) You, likewise, made me laugh with your child-like naïveté. With professionalism like this, you'll make a fine "eye doctor", Doctor! :)
:thumbup:
 
PBEA said:

That's great, you want to play petty semantics, you go ahead. If MD's want sole possession of the term doctor, then they can have it. But then NO ONE else gets to use it, not dentist, vet, OD, PhD, etc, etc. Further more, if this stupid bill passes, then I propose that the OD (and OMD's?) get together and pass a law LIMITING ANY AND ALL EYE DIAGNOSIS AND TREATMENTS, TO THOSE THAT RECIEVE ADEQUATE TRAINING IN THIS FIELD OF MEDICINE, NAMLEY OD's AND OMD's, NO ONE ELSE. We'll call it the "Tranparency in Eyecare Bill", and that would be a bill that would fly through the legislature like greased lighting, you know why? Because it would be sooo simple to show how people like you (non-ophth,non-OD) really know nothing about eyecare.

I suggest, in your free-time, you consider a few additional college-level courses. First, reading comprehension. Second, logical reasoning. They might help in future debates.

No one, least of all me, ever said an OD should not be referred to as "doctor". What I did say, repeatedly, is that the aim of this Bill is to keep non-physicians in being "honest" in their advertising and self-promotion. Dr. Bob Edwards should be Bob Edwards, O.D. They both say the same thing, but one connotes physician in the uneducated public's eye, whereas the other clarifies that Bob is an optometrist. Eye "doctor" may not be deceptive, but it does create a degree of confusion. Saying optometrist is true-in-fact and does not confuse anyone.

I believe my point was that you DO NOT see other professionals going around capitalizing on this ambiguity of terms. You don't see dentists deliberately going around saying "tooth doctor", but they could, couldn't they? You don't see psychologists going playing word games with patients. That was my whole point.
 
ProZackMI,

Thanks for your posts in this thread. Excellent. You echo many things I have felt about optometry for the past 8 years and I appreciate the thougt you've put into your posts and your willingness to share them.

I must admit that a lot of pre-optometry students and early optometry students are fed a line from organized optometry that doesn't bear out in reality. We are told we are primary care eye doctors but have no idea what primary care really is. We don't work with patient's systemic disease, although we claim we are taught systemic disease. The real optometric world is a harsh mistress and as the reality of optometry sets in we often sound bitter, angry, and as a few of the recent posts show, a bit ignorant.

Thanks again
 
no offense taken, as i am not a dentist! here is a link, if you are interested:

http://www.ada.org/public/resources/history/timeline_ancient.asp

it looks like the first realistic approach to dentistry was in 2600 bc. a year or two before barbers joined the ranks. 500-300 BC, Hippocrates and Aristotle began studying this stuff. once again, people a bit more qualified than barber joe on the corner. optometry may very well have been started in a jewelry store. dentistry, as it turns out, was not started in the barber shop. in 1210, it looks like a guild of barbers split in two: 1 group becoming educated in oral surgery, etc, and the other, "lay barbers" who continue to cut hair, and perform general hygienic care. perhaps one could more appropriately infer that dental hygiene has its roots in the barber shop. :D

drgregory said:
i always thought some of the first dentists were barber shop owner (no offense). the first optometry roots came from jewelry shops. both are pretty non-medical, unless im mistaken on the roots of each.
 
1130-1163—A series of Papal edicts prohibit monks from performing any type of surgery, bloodletting or tooth extraction. Barbers often assisted monks in their surgical ministry because they visited monasteries to shave the heads of monks and the tools of the barber trade—sharp knives and razors—were useful for surgery. After the edicts, barbers assume the monks’ surgical duties: bloodletting, lancing abscesses, extracting teeth, etc.

1210—A Guild of Barbers is established in France. Barbers eventually evolve into two groups: surgeons who were educated and trained to perform complex surgical operations; and lay barbers, or barber-surgeons, who performed more routine hygienic services including shaving, bleeding and tooth extraction.

1400s—A series of royal decrees in France prohibit lay barbers from practicing all surgical procedures except bleeding, cupping, leeching, and extracting teeth.
http://www.ada.org/public/resources/history/timeline_midlage.asp
 
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