I think most of the things in this bill qualify as 'surgical' or 'procedural.' There's plenty of vascular surgeons who would call vein stripping or harvesting a saphenous vein graft a 'procedure' but it's sure surgical. More often I see them use terms like "minor surgery" and "major surgery." Most of this bill is talking about 'minor surgery' I suppose, but if you ask a General Surgeon about cataract surgery they'll tell you it's minor surgery too, because they've never seen one. It's all just nomenclature. This bill includes things like excisions of skin lesions which I consider to be minor surgery. Lid lac repair and foreign body removal most would consider surgery. I've seen people come back with pretty nasty complications from "simple" biopsies. The bill has things in it like needle drainage of a hematoma or abscess that can end up getting nasty. And again you have to consider what's in the patient's best interest. If you botch that lid lac, who are you going to send that patient to? I'm not going to take the risk of being involved in that case. I can imagine it being pretty hard to find an Oculoplastics doc who was willing to see a complication of lid lac surgery performed by an Optometrist.
I have no doubt that many Optometrists are performing below their level of training, but if you don't use it you lose it. I ran codes, put in central lines, managed ventilator settings, etc as an intern this year. Even a year from now I likely wouldn't feel safe doing this stuff. The knowledge I've gained will be useful in many ways, but the skills and intimate knowledge with the finer points of this stuff gets lost over time from disuse. And you and I both know that most Optometrists don't manage a whole whole lot of things like we see in this bill in their clinics every day. In my experience which is admittedly limited, it's the Optometrists working in clinic alongside Ophthalmologists who see the most medical pathology. If there were fewer Optometrists then you'd be seeing more diverse pathology per provider and likely wouldn't have that danger.
I think the best possible outcome for everyone would be the following:
1. Shut down maybe half of the Optometry schools in existence, maybe even more, and severely decrease the number of ODs currently in training. Everybody knows there are way more Optometrists than needed and we've known it for years. Control your educational arm. Look at lawyers to see where this is leading.
2. This leads to a higher volume of patients per each Optometrist, exposing them to a larger and broader volume of pathology
a. If point #1 happened, I bet you'd see a lot more partnership between medical schools and optometry schools. Take a look at Podiatry training - there are very few schools (I think 8 total) and most of them do the first two years side by side with medical students taking the same courses. There is some tension at times between Ortho and Podiatry, but most of the time the residents and attendings work well together.
b. Side effect of seeing more patients is greater income per Optometrist, making it again a more attractive field and attracting higher quality applicants to the now more competitive spots available
3. These things put Optometrists into a position to greater utilize their medical training, and in fact have more medical training in Optometry school. It's better for patients and better for everyone.
I'm pretty pessimistic though, and I doubt this will ever happen. Most likely more new schools will continue to open and the supply of Optometrists will be so abundant that, like many law school grads, you'll have to find work outside of eye care. Your salaries will continue to plummet and we'll continue to fight over scope incessantly. The only way to fix this would be a massive organization of Optometrists to smack the ACOE into line on this matter. It would also help if the AOA would stop lying about salaries and job prospects with information like can be found on
this page stating salaries on average for Optometrists is $130,000. Quite frankly, I've seen Optometrist job offers in clinics where I know the Ophthalmologists. Even in those practices where Optometrists usually enjoy higher income, the salaries are declining. Why would the AOA continue to disburse such misleading data? They have to know that they are outright lying. The crash is already happening with law school, and the writing seems to be on the wall for Optometry too unless some vast and sweeping changes are made. I'll put it this way: I know plenty of Ophthalmology residents and young Ophthalmologists whose parents are ODs. Their parents didn't encourage them to go to Optometry school to take over the practice. They went to medical school and became Ophthalmologists, and from what I know all of their parents thought that was a much better plan. That says something to me about what those successful ODs think about the stability of Optometry in the future.
I don't mean to keep sidelining this, but I think the scope of practice and training/supply issues for Optometry are inseparable.
).
