New optom curriculum?

[200UL]

Now that optometry is one signature away from having identical surgical abilities as ophthalmology, have your schools implemented the new curriculum yet that allows for training on: cataract surgery, enucleation, strabisumus surgery... Will it be a 6 hour course like the pharmacology/pathology course? Maybe a wet lab with a couple of pig eyes?

The law states optometry can perform these procedures with no ability for another agency to judge competency. I just wanted to know how this was being dealt with in the classroom.

I know most of you reading this will never desire what this bill asks for, but your leaders are a bunch of frauds.

The scary thing is that your profession will never be able to deal with the implications of the bill as it is written. Again, I believe an "ask for the world, hope we get a little approach" was taken. The problem is that in Kentucky they gave it all to you. If this actually goes through, it will be fascinating to watch how you cram a complete surgical curriculum into 4 years of optometry school. Minor details.....

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[nc2tarheels]

get lost.

 

[socal2014]

Now that optometry is one signature away from having identical surgical abilities as ophthalmology, have your schools implemented the new curriculum yet that allows for training on: cataract surgery, enucleation, strabisumus surgery... Will it be a 6 hour course like the pharmacology/pathology course? Maybe a wet lab with a couple of pig eyes?

The law states optometry can perform these procedures with no ability for another agency to judge competency. I just wanted to know how this was being dealt with in the classroom.

I know most of you reading this will never desire what this bill asks for, but your leaders are a bunch of frauds.

The scary thing is that your profession will never be able to deal with the implications of the bill as it is written. Again, I believe an "ask for the world, hope we get a little approach" was taken. The problem is that in Kentucky they gave it all to you. If this actually goes through, it will be fascinating to watch how you cram a complete surgical curriculum into 4 years of optometry school. Minor details.....

I agree....optometry should not try to force its way into other professions. For the OD's who want to do surgery, go to medical school. Do OD's even want do surgery...or do they just want to increase their scope of practice? Two very different scenarios.

Besides, Optometry has other problems to deal with such as over supply and insurances. Only an idiot would think that increasing the scope would get rid of all these issues.

 

[kanglq]

Now that optometry is one signature away from having identical surgical abilities as ophthalmology, have your schools implemented the new curriculum yet that allows for training on: cataract surgery, enucleation, strabisumus surgery... Will it be a 6 hour course like the pharmacology/pathology course? Maybe a wet lab with a couple of pig eyes?

Does it concern you now that ODs have the ability to make similar amounts of money without the same levels of stress as working as an MD?

Why are you making such a big deal out of this. If the entire country passes a bill such as this, then the courses will change to accommodate the extra training involved.

Don't be a f*** and feel you're superior to everyone.

 

[thecgrblue]

Does it concern you now that ODs have the ability to make similar amounts of money without the same levels of stress as working as an MD?

Why are you making such a big deal out of this. If the entire country passes a bill such as this, then the courses will change to accommodate the extra training involved.

Don't be a f*** and feel you're superior to everyone.

Probably getting peeved with the idea that someday we may be able to learn basic techniques without spending 8 years busting our brains out.

 

[Meibomian SxN]

Probably getting peeved with the idea that someday we may be able to learn basic techniques without spending 8 years busting our brains out.

Exactly! But they can still continue to examine their "fecal incontinence" patients

I'm more interested in their iris sphincter concern, not the anal sphincter!

 

[200UL]

Pathetic. thecrglue and kanglq will make excellent leader in optometry some day.

I do not feel superior to anyone. However, I choose to go to medical school to become and eye surgeon. You had the same opportunity if you wanted to take it...

I can assure you that I am not upset that you make more or less money than MDs.

For your knowledge, I enjoyed every year of my training and am thankful everyday for it. I have no regrets. At times I wish I would have studied harder or had more clinical or surgical experiences. Why? - because patient outcomes matter to me professionally and personally.

It does bother me that you and your leaders can look at the Kentucky bill and feel good about it (I know many optometrists do not). Knowing what I know/having the experiences I have and continue to have on a daily basis, you all are ignorant or do not care about patients.

 

[nc2tarheels]

you're only here to try and start ****, so just go back to the optho board. If we wanted to discuss this bill with an optho, we'd come to your forum. It's pretty obvious that you aren't here to do the same, only to troll.

 

[JaggerPlate]

Probably getting peeved with the idea that someday we may be able to learn basic techniques without spending 8 years busting our brains out.

I wonder if these 8 years of 'worthless' medical training would come in handy during some sort of medical emergency in the middle of an eye surgery? Why don't you ask Meibomian. He explained what he would do if this happened during a surgical procedure in the Ophthalmology forums (guess he was trolling too), and every O-MD/DO's jaw dropped to the floor at the comment as they explained that he'd caused the patient to go blind.

Reponse: "I guess I learned something."

I wonder if the now blinded patient thinks those additional 8 years of medical and surgical training were worthless? The hubris is unbelievable.

 

[thecgrblue]

I wonder if these 8 years of 'worthless' medical training would come in handy during some sort of medical emergency in the middle of an eye surgery? Why don't you ask Meibomian. He explained what he would do if this happened during a surgical procedure in the Ophthalmology forums (guess he was trolling too), and every O-MD/DO's jaw dropped to the floor at the comment as they explained that he'd caused the patient to go blind.

Reponse: "I guess I learned something."

I wonder if the now blinded patient thinks those additional 8 years of medical and surgical training were worthless? The hubris is unbelievable.

Did I say 'worthless'? Nope...I highly respect what you learn and are able to do. I just know how to push your buttons and I felt like doing it.

 

[thecgrblue]

Pathetic. thecrglue and kanglq will make excellent leader in optometry some day.

I do not feel superior to anyone. However, I choose to go to medical school to become and eye surgeon. You had the same opportunity if you wanted to take it...

I can assure you that I am not upset that you make more or less money than MDs.

For your knowledge, I enjoyed every year of my training and am thankful everyday for it. I have no regrets. At times I wish I would have studied harder or had more clinical or surgical experiences. Why? - because patient outcomes matter to me professionally and personally.

It does bother me that you and your leaders can look at the Kentucky bill and feel good about it (I know many optometrists do not). Knowing what I know/having the experiences I have and continue to have on a daily basis, you all are ignorant or do not care about patients.

Nah, I'm a lot nicer in real life. I will poke and prod you like a little sibling on internet forums b/c I can hide behind a false facade. Shoot, I may not even BE a student.

 

[bobbio]

I agree....optometry should not try to force its way into other professions. For the OD's who want to do surgery, go to medical school. Do OD's even want do surgery...or do they just want to increase their scope of practice? Two very different scenarios.

Besides, Optometry has other problems to deal with such as over supply and insurances. Only an idiot would think that increasing the scope would get rid of all these issues.

Hit the nail right on the head. OD leaderhsip should try to fix existing problems as opposed to creating more.

 

[nc2tarheels]

I wonder if these 8 years of 'worthless' medical training would come in handy during some sort of medical emergency in the middle of an eye surgery? Why don't you ask Meibomian. He explained what he would do if this happened during a surgical procedure in the Ophthalmology forums (guess he was trolling too), and every O-MD/DO's jaw dropped to the floor at the comment as they explained that he'd caused the patient to go blind.

Reponse: "I guess I learned something."

I wonder if the now blinded patient thinks those additional 8 years of medical and surgical training were worthless? The hubris is unbelievable.

He didn't start a new thread on this **** when there's already several threads all over the place, talking about this specific topic.

 

[kanglq]

you're only here to try and start ****, so just go back to the optho board. If we wanted to discuss this bill with an optho, we'd come to your forum. It's pretty obvious that you aren't here to do the same, only to troll.

Totally agree!

 

[Optogal]

Now that optometry is one signature away from having identical surgical abilities as ophthalmology, have your schools implemented the new curriculum yet that allows for training on: cataract surgery, enucleation, strabisumus surgery... Will it be a 6 hour course like the pharmacology/pathology course? Maybe a wet lab with a couple of pig eyes?

Is this literally true or hyperbole?

I'm not going to try to read through the details (I'm in Canada) - but is this a literal interpretation of the proposed law?

 

[DILLIGAF]

Ok, so it appears once again that someone decided to rattle the hornet's nest by coming into an OD forum and basically saying that we will not have the training to do what the bill asks for...and whether this is true or not, you must understand that simply by virtue of writing in an OD forum as an MD, and claiming future incompetence, that this is inherently acting hollier than thou...it will only go in one direction. An OD can't go to an MD forum and start telling them what they are wrong in. The only reason that this occurs is because it is felt the accusers "professional rank" outweighs those he is speaking to, and that their knowledge of the issue (in our case eyes) can't be touched. So please do not act as if it is innocuous and unassuming to post what was posted. It would never work the other way, and there is a reason for that, which many feel is being taken advantage of.

As to the issue at hand, I for one am VERY tired of states with supply issues (Kentucky and Oklahoma) getting bandied about as if they represent any realities on the ground for optometry. These are small states with very sparse populations, thus it is felt that ANY doctor should not be held back by virtue of how few there may be in some areas....these are isolated incidents, all of which cover up the fact that in the three most populous states, NY, FL, and CA, optometric laws are dead in the water. You get to do an iridotomy in KY? Good for you. Come down to FL and an OD cannot even give out basic glaucoma meds. Oklahoma has had OD's doing surgeries for years with very little problems, and in the event that KY gets it too, I am sure the sun will rise again tomorrow. These are wedge issues that are raised up for the explicit purpose of fending off optometry, and to show the superior training that MD's get. It is not as if the patients of KY are even being debated here. It is all a pathetic pride fight on both sides, and that makes me want to vomit.

The true reason that this bill will pass in KY is the same reason that there is a bill (House bill 549) being brought up in the FL house, which will effectively give opticians refracting rights. It has no chance of passing, but it was brought up as diversion for the fact that ophthalmology's titan, Alan Mendelsohn, is currently sitting in a jail cell for very blatantly bribing officials to get his way for his craft. The AMA still holds a strangle hold on the large states, and little KY can go and do OD macular hole surgeries if they want and the facts will not change. The bill has a chance in KY because of a massive fund raising effort by a lot of Lexington OD's over several years, which had waited for a long time for its legislative opportunity to unleash its (still small, all OD funded) war chest. Anyone that thinks this is about patients, about MD vs OD, about anything other than who can write the biggest check at the time when the votes against look weakest, that person is delusional about how things get done at the state level in the US. The new change over in house seats since the new house took their places saw a lot of ophthalmology's water-carriers (Bascom, Mitar, Edgarson) get voted out, and the AOA there saw how many of its own water-carriers were still around before releasing the money it had built up.

So, in other words, none of the stuff people are bleating on about has a lick to do with optometry in the US, or really with patients in KY. It is about money and votes. Sorry. If you want to keep talking about "training" and "my residency was this" you can go right ahead, but that isn't what moves and shakes this debate in the real world. Sorry to spoil the hate fest.

 

[200UL]

Is this literally true or hyperbole?

I'm not going to try to read through the details (I'm in Canada) - but is this a literal interpretation of the proposed law?

From a procedure standpoint, the bill provides a big list of exclusions: "non laser enucleation, non laser lens extraction, non laser strabismus surgery, non laser conjunctiva surgery" Therefore, if these procedures can be done with a laser, this bill says it is in the scope of what defines optometry in KY.

I do not write bills/laws, but I promise you every line has importance.

DILLIGAF
This is not about rank – you have every right to question my profession. You will struggle with critiquing medicine, however, in the standards/ formalized curriculum that have been developed in creating a physician/surgeon in any discipline. This process gets more rigorous each year.

Do not belittle states like KY or OK and make them seem irrelevant to medicine in this country. I believe that is disrespectful to your colleagues there and to the citizens of the states. The question remains, do the optometrists have the ability/training to do nearly every ophthalmic surgery ophthalmologists do (that is what the bill asks for)? Show the country the equivalent or superior curriculum. Show the country the equivalent or superior training.

 

[cjensen20]

who is to say that the majority of optometrists want to do surgery?

 

[Bioflare]

who is to say that the majority of optometrists want to do surgery?

This is exactly the point, it seems that most optometrists would rather not operate on patients, for those that do the legislation in that specific state helps them out.

This thread is all about ophthalmologists losing out on their education? You're still MD's for god sake and will make more money so don't complain so much. If you're trying to say whats best for the patient, well any patient would at least take the time to research the difference between an Optometrist and an Opthamologist, and more often than not they will go with the MD. But that is generalizing, there are examples of very bad doctors and very good doctors can you say honestly that every single doctor is better and more capable than every optometrist? I would think not, as there are individuals that could have easily attended medical school and gone on to specialize (take a look at UWaterloo entering statistics for Optometry).

For the 4 years to be able to surgery, I disagree with this. I believe as the laws change the curriculum will change but only to inform Optometry students of what they might want to explore. I believe that an addition 3-4 years of specializing is a requirement as a minimum before allowing someone to do surgery of any sort.

 

[Visionary]

Not looking to kick the hornets' nest that 200UL stirred up, but I wanted to comment on this post.

This is exactly the point, it seems that most optometrists would rather not operate on patients, for those that do the legislation in that specific state helps them out.

What you state here seems to be true, much as most ophthalmologists don't have a problem with optometrists having broader medical privileges. Unfortunately for both our camps, the few who are pushing the national agenda are extremists.

This thread is all about ophthalmologists losing out on their education? You're still MD's for god sake and will make more money so don't complain so much. If you're trying to say whats best for the patient, well any patient would at least take the time to research the difference between an Optometrist and an Ophthamologist, and more often than not they will go with the MD.

Have already gotten into this with Meibomian SxN multiple times before. What you describe does not happen that much. Most patients don't know the difference and don't research it. They are just looking for an "eye doctor."

But that is generalizing, there are examples of very bad doctors and very good doctors can you say honestly that every single doctor is better and more capable than every optometrist? I would think not, as there are individuals that could have easily attended medical school and gone on to specialize (take a look at UWaterloo entering statistics for Optometry).

Agreed. I know of ophthalmologists who I wouldn't send my enemies to. There are also optometrists I would trust my family with. Those who graduate at the bottom of the class, at the worst schools, in both of our training paths are still called "doctor."

For the 4 years to be able to surgery, I disagree with this. I believe as the laws change the curriculum will change but only to inform Optometry students of what they might want to explore. I believe that an addition 3-4 years of specializing is a requirement as a minimum before allowing someone to do surgery of any sort.

This is what many of us ophthalmologists are arguing about. If you can show equivalency of training, we have no argument to make. You can become an internist via allopathic or osteopathic schools. Alternative, differing pathways to the same end are fine, as long as they are equivalent. That does not yet exist for optometry and surgery.

 

[20DOC20]

What bill is being referred to? What new curriculum?

I've been in practice 15 years. In my state, we can legally do injectables and minor surgical procedures such as Kenalog injections and hordeolum removal. We can also Rx orals.

Personally ... I'd NEVER touch any of the surgical stuff, including Kenalog inj. Too much risk in irreversible scarring if it's done wrong. Too much risk penetrating the globe. And if someone else can do it better, referral is a valid, sound form of treatment.

But, it is nice to finally be able to Rx Doxycycline for ocular rosacea, and rx occasional pain meds. But ... that's all I'd ever want to do.

I have removed corneal fb's for years and years. Those are pretty easy. Conjunctival fb's still go out. We've not been trained in sutures here. I once removed grasshopper legs of some guy's conj and that was fun. No sutures required

The AOA for some reason has pushed and pushed and pushed and why??? Their political agenda does not represent the silent majority of OD's. OD's being trained in strab sx, cat sx, enucleation is weird. I could see knowing the particulars of a surgical procedure for the sake of better educating and reassuring patient before and after a referral ... but actually doing it? Is this true?

And is this in OD programs or OMD programs? I don't know too much about the latter. It came after my time. I'm just an old fogie!

If I had wanted to go to med school, I could have. I had the grades for it. I chose not to because the sight of blood makes me want to vomit. Even seeing purulent discharge in a red eye on high magnification to this day makes my stomach turn.

We need the MD's. Let them do the surgery!!! It's nasty, has high overhead, high liability. Plus, it's gross. Why bother? Plus, there are things that can happen with these procedures, complications that are extraordinarily NASTY! Some of the MD's I worked with described cases of eyeballs ... what's the term ... everting? during cataract Sx when they did charity work outside the us. The eye can turn inside out. Strab sx, I mean, you can cut a muscle. Enucleation ... who'd want to be responsible for attaching the muscles to a ball to prepare for a moveable implant?

If this is true, optometry's lost it's mind.

Just 2 cents from an old fogie.

 

[Shnurek]

Basically, what I am getting from these forums and especially KHE is that ODs are pushing for surgery and getting it in some states so they can use it as a bargaining chip to get full medical privileges in all the 50 states instead of having to fight over every single new item that comes out.

Massachusetts for example doesn't even allow ODs to treat glaucoma or RX orals. ODs are the most hindered in that state and many ODs are pissed off about this and that is why they are employing these eccentric tactics.

 

[IndianaOD]

What bill is being referred to? What new curriculum?

I've been in practice 15 years. In my state, we can legally do injectables and minor surgical procedures such as Kenalog injections and hordeolum removal. We can also Rx orals.

Personally ... I'd NEVER touch any of the surgical stuff, including Kenalog inj. Too much risk in irreversible scarring if it's done wrong. Too much risk penetrating the globe. And if someone else can do it better, referral is a valid, sound form of treatment.

But, it is nice to finally be able to Rx Doxycycline for ocular rosacea, and rx occasional pain meds. But ... that's all I'd ever want to do.

I have removed corneal fb's for years and years. Those are pretty easy. Conjunctival fb's still go out. We've not been trained in sutures here. I once removed grasshopper legs of some guy's conj and that was fun. No sutures required

The AOA for some reason has pushed and pushed and pushed and why??? Their political agenda does not represent the silent majority of OD's. OD's being trained in strab sx, cat sx, enucleation is weird. I could see knowing the particulars of a surgical procedure for the sake of better educating and reassuring patient before and after a referral ... but actually doing it? Is this true?

And is this in OD programs or OMD programs? I don't know too much about the latter. It came after my time. I'm just an old fogie!

If I had wanted to go to med school, I could have. I had the grades for it. I chose not to because the sight of blood makes me want to vomit. Even seeing purulent discharge in a red eye on high magnification to this day makes my stomach turn.

We need the MD's. Let them do the surgery!!! It's nasty, has high overhead, high liability. Plus, it's gross. Why bother? Plus, there are things that can happen with these procedures, complications that are extraordinarily NASTY! Some of the MD's I worked with described cases of eyeballs ... what's the term ... everting? during cataract Sx when they did charity work outside the us. The eye can turn inside out. Strab sx, I mean, you can cut a muscle. Enucleation ... who'd want to be responsible for attaching the muscles to a ball to prepare for a moveable implant?

If this is true, optometry's lost it's mind.

Just 2 cents from an old fogie.

I do think it makes sense for optmetrists to go ahead and perform some of the minor procedures. YAG, SLT, and external lumps and bumps. An external kenalog injection is a less invasive procedure than a piercing or tatoo. I think ODs are a little more trained than a piercing artist. These are technical procdures that any reasonable provider can perform and ODs already know when they are needed.

I don't think ODs anywhere are pushing for cataract surgery or trabs.

Medicine has put much greater emphasis on procedures than exams. Thus they are basically forcing providers to perform procedures to earn a decent living.

With orgnaized ophthalmolgy's relentless attacks, optometry has to keep pushing forward or risk going backwards.

I think a lot of MDs don't realize that ODs graduate specialists unlike and MD that has just completed medical school and knows a little about a lot of things but needs residency to be a specialized practicioner.

 

[Visionary]

I do think it makes sense for optmetrists to go ahead and perform some of the minor procedures. YAG, SLT, and external lumps and bumps. An external kenalog injection is a less invasive procedure than a piercing or tatoo. I think ODs are a little more trained than a piercing artist. These are technical procdures that any reasonable provider can perform and ODs already know when they are needed.

I don't think ODs anywhere are pushing for cataract surgery or trabs.

Medicine has put much greater emphasis on procedures than exams. Thus they are basically forcing providers to perform procedures to earn a decent living.

With orgnaized ophthalmolgy's relentless attacks, optometry has to keep pushing forward or risk going backwards.

I think a lot of MDs don't realize that ODs graduate specialists unlike and MD that has just completed medical school and knows a little about a lot of things but needs residency to be a specialized practicioner.

You're kidding, right? This post is so ridiculous, I'm not even sure how to approach it--spelling and grammatical errors notwithstanding.

 

[IndianaOD]

You're kidding, right? This post is so ridiculous, I'm not even sure how to approach it--spelling and grammatical errors notwithstanding.

Sorry English chief. I typed the reply quickly and the computer I was using did not have spell check. It is more of a mistype than a misspelling. Some people have to work to make a living and I don't spend much time on this site. I saw two mildly misspelled words. I absolutely can't stand spelling/grammar police. Really?

Let's have at it. What do you find ridiculous?

You know what is ridiculous? A piercing artist can basically perform a full thickness "injection" through the entire eyebrow. An optometrist can't stick a needle in a chalazion after 8-9 years of education. I would wager a 4th year OD student has more practice with a slit lamp than an MD who does their first YAG.

I have great respect for most of the MDs I share patients with (there are crappy doctors of all types) but most of them have no clue what an OD's training and capabilities are. Even one of my best friends from undergrad who is now an ER doc was totally clueless. Now he frequently asks for my opinion on cases after he spent some vacation time with me. I see frequent mismanagement of ocular conditions by non-OMD MDs and I don't rake them over the coals or tell the patients they screwed up. I know at least two cases could have gone to court if things hadn't gone differently.

Hopefully I did not exceed my grammatical error quota.

 

[Visionary]

OK, Indy, here goes.

I do think it makes sense for optmetrists to go ahead and perform some of the minor procedures. YAG, SLT, and external lumps and bumps. An external kenalog injection is a less invasive procedure than a piercing or tatoo. I think ODs are a little more trained than a piercing artist. These are technical procdures that any reasonable provider can perform and ODs already know when they are needed.

It makes sense for optometrists to perform procedures they have not been trained for? Not sure I follow your logic here. How about YAG capsulotomies? Why can't the patient's cataract surgeon perform that? SLTs? OK, then go do a glaucoma laser fellowship. There's no way you would get enough experience in optometry school. As far as "external lumps and bumps," such terminology really minimizes the potential pathology. Is it a papilloma, a skin tag, a hordeolum, a chalazion, a cyst, a basal cell, a squamous cell, or maybe even a sebaceous cell? Sure, most lesions will be benign, but without the extent of actual clinical experience (not textbooks), I don't think you can adequately discriminate some of them, and you definitely shouldn't be excising them. I do some comprehensive ophthalmology, and even I refer the lid lesions to our plastics guy. Then, comparing a Kenalog (I assume you are referring to eyelid) injection to a piercing or tattoo is ludicrous. In any case, let's evaluate your comparison. First, I would argue that they are equally invasive, as both involve piercing of the skin and tattooing involves injection of a substance. Furthermore, I would bet that a piercing or tattoo artist accumulates much more hands-on experience before opening up a shop than an optometry graduate does for periocular injections. As far as differences, one is medical and the other is cosmetic. If you don't understand these points, why am I to believe you would know when such a procedure is needed?

I don't think ODs anywhere are pushing for cataract surgery or trabs.

Yet...but as you say:

With orgnaized ophthalmolgy's relentless attacks, optometry has to keep pushing forward or risk going backwards.

So, who knows what's next. Of course, I would rephrase by stating that ophthalmology is on the defensive from the attacks of organized optometry, but potato vs. potatoe there.

Medicine has put much greater emphasis on procedures than exams. Thus they are basically forcing providers to perform procedures to earn a decent living.

So, this is a money, rather than patient care, issue. The answer for you then is to steal procedures from ophthalmology to make up for the generalized cuts in health care reimbursements? How nice of you.

I think a lot of MDs don't realize that ODs graduate specialists unlike and MD that has just completed medical school and knows a little about a lot of things but needs residency to be a specialized practicioner.

We ophthalmologists understand full well that optometrists complete a 4 year graduate training program that is eye specific, and that's to be commended. However, we also understand that many claim equivalency of training compared to 4 years of medical school plus a year of internship and 3 years of ophthalmology residency. That's sort of like comparing a nurse practitioner to an internist (though perhaps less so, as some NPs complete a 4 year specific BSN, followed by a doctorate in nursing). Yes, medical school and internship is not eye specific, but it lays the groundwork for a much more thorough understanding of the human body than anything you learn in optometry school. As some of your own brethren have stated on this forum, optometry school really only prepares you for the optical and rudimentary medical portions of eye care. You simply do not get enough clinical experience in optometry to be a true primary medical eye care provider. If you pursue internship, residency, or fellowship post-doctoral clinical training, such as KHE or others on this forum, that's another story. The fact is that there simply is no substitute for clinical exposure. Some programs, like Oklahoma, seem to be doing it right. They have much smaller class sizes, which increases the available clinical exposure per student. Still, the number of clinical hours pales in comparison to an ophthalmology residency. An ophthalmology residency is about 90% clinical time over 3 years, because we have gotten the majority of our coursework out of the way in medical school. I'm sorry, but optometry school is not even close. When optometry can demonstrate equivalent training, the arguments of ophthalmology will be silenced. Until then....

 

[Shnurek]

When optometry can demonstrate equivalent training, the arguments of ophthalmology will be silenced. Until then....

Again another thread that went into the unending OD vs OMD debate lol

Chicken or the egg Visionary. Which came first?

Optometry will demonstrate equivalent training when there is legislation that allows optometrists to do everything ophthalmologists can do. Do you really want your arguments to be silenced? lol

 

[DILLIGAF]

To the poster that replied that this thread devolved into another OMD vs OD; the original post was intended to inquire about whether the optometry curriculum should be changed....so this seems like a rather logical endpoint. I.E. Its resemblance to the medical model. Anyway, here are my two cents:

I am of the opinion that optometry schools are stuck in the past, as least in so much as clinical experience goes. Optometry arose out of jewelry stores and small time merchants that would custom glasses for people. We started as simple spectacle makers, NOT doctors. We were no different than the guy that made shoes, made wedding rings, etc....this was decades ago.

As time went on, the demand for glasses and the understanding of our visual health along with our ability to change it, exploded. Put simply, the demand for visual care outsized the small contingent of OMD's and glasses makers. Optometry needed to step up to meet it, and the rest is history....fast forward this to today, and to the HUGE complexity that we now know of in the visual system. There are more known pathologies, more drugs, more clinical tells, etc. Today, being able to simply refract does very little for many patients. The eyes "went global" in our understanding of vision, and by this I mean to say that we now more fully understand the inputs of the rest of the body into visual health. With this all said, I am of the opinion that optometry schools have not yet fully adjusted to this new reality.

In as short as I can put it, I believe that optometry should go more the way of dentistry. By this, I mean that there should be a core degree that is taught to all, but that past this point additional training should be given if the doctor would like to expand scope for themselves. An OD should be required to take at least a year residency to do anything past refraction, perhaps 2 years to do VERY basic interventions, and 3-4 years to do surgeries. In doing so, optometry would become more like the "as taught" system that dentistry and medicine in other countries use.

By saying this, I am saying POINT BLANK that the idea that a 26 year old OD with no residency is equal to an OMD with 4 years of med school and a 3-4 year residency is an indefensible position, insomuch as ANYTHING to do with spotting or treating disease....now, is the OD better at solving a BV issue? Probably. Are their refractive skills likely sharper? Can they rx a better low vision telescope? Also likely...again, it is all about experience, and if an OMD is better at spotting disease through their clinical time in it, it is illogical to think that an OD that spend 4000 contact hours doing it would not be better than an OMD that did 1000....

The good news is that I believe that optometry WILL eventually head this direction, mainly due to economics. Also, the institutionalized hubris that medical school imparts on its grads is, for me, very damaging in this debate. Case in point, the recent KY law...the other side was basically arguing that optometrists have no business doing anything but subjective refraction on people, and they got their lunch handed to them. I realize that medical school gives 4 years on the entire human body, and that this correlates into a better diagnostician when combined with 3 years of residency....but the fact remains that when those residents show up, they know (or at least remember) very little about the eyes. At my VA clinic, the OD's TEACH the OMD residents WHAT a slit lamp does and how to use it. They teach how to instill drops, how to refract with more speed, about BV problems, etc. I saw an OD last month explain to one of our MD residents WHY a flame heme looks the way it does. This is all the norm. As I sit there and watch this happen, I can't help but think, "Wow, in 3-4 years time, that person will be able to cut your sclera open and blast you with a ruby laser." Now, if someone were to come and tell me that those SAME OD residents couldn't do the same surgeries with that kind of 3-4 year, day in and out training? That is crazy...

Optometry school should embody more of the medical model, spend more time on systemic disease, etc. That part is hard to argue against for me. The fact that students now spend 2 years on optics, 2 years on ABV, along with the other "old optometry" model classes; this is all overkill and is time that should have been spent on learning internal medicine, heart and renal, etc. One semester of pathology, ocular anatomy, ocular phizio, that is simply not enough to understand the full scope of vision we are now aware of. Optometry school SHOULD change, but this change will only come with the requisite hope that IF we change, we will get the respect to receive the training we deserve. Thank you.

 

[Visionary]

To the poster that replied that this thread devolved into another OMD vs OD; the original post was intended to inquire about whether the optometry curriculum should be changed....so this seems like a rather logical endpoint. I.E. Its resemblance to the medical model. Anyway, here are my two cents:

I am of the opinion that optometry schools are stuck in the past, as least in so much as clinical experience goes. Optometry arose out of jewelry stores and small time merchants that would custom glasses for people. We started as simple spectacle makers, NOT doctors. We were no different than the guy that made shoes, made wedding rings, etc....this was decades ago.

As time went on, the demand for glasses and the understanding of our visual health along with our ability to change it, exploded. Put simply, the demand for visual care outsized the small contingent of OMD's and glasses makers. Optometry needed to step up to meet it, and the rest is history....fast forward this to today, and to the HUGE complexity that we now know of in the visual system. There are more known pathologies, more drugs, more clinical tells, etc. Today, being able to simply refract does very little for many patients. The eyes "went global" in our understanding of vision, and by this I mean to say that we now more fully understand the inputs of the rest of the body into visual health. With this all said, I am of the opinion that optometry schools have not yet fully adjusted to this new reality.

In as short as I can put it, I believe that optometry should go more the way of dentistry. By this, I mean that there should be a core degree that is taught to all, but that past this point additional training should be given if the doctor would like to expand scope for themselves. An OD should be required to take at least a year residency to do anything past refraction, perhaps 2 years to do VERY basic interventions, and 3-4 years to do surgeries. In doing so, optometry would become more like the "as taught" system that dentistry and medicine in other countries use.

By saying this, I am saying POINT BLANK that the idea that a 26 year old OD with no residency is equal to an OMD with 4 years of med school and a 3-4 year residency is an indefensible position, insomuch as ANYTHING to do with spotting or treating disease....now, is the OD better at solving a BV issue? Probably. Are their refractive skills likely sharper? Can they rx a better low vision telescope? Also likely...again, it is all about experience, and if an OMD is better at spotting disease through their clinical time in it, it is illogical to think that an OD that spend 4000 contact hours doing it would not be better than an OMD that did 1000....

The good news is that I believe that optometry WILL eventually head this direction, mainly due to economics. Also, the institutionalized hubris that medical school imparts on its grads is, for me, very damaging in this debate. Case in point, the recent KY law...the other side was basically arguing that optometrists have no business doing anything but subjective refraction on people, and they got their lunch handed to them. I realize that medical school gives 4 years on the entire human body, and that this correlates into a better diagnostician when combined with 3 years of residency....but the fact remains that when those residents show up, they know (or at least remember) very little about the eyes. At my VA clinic, the OD's TEACH the OMD residents WHAT a slit lamp does and how to use it. They teach how to instill drops, how to refract with more speed, about BV problems, etc. I saw an OD last month explain to one of our MD residents WHY a flame heme looks the way it does. This is all the norm. As I sit there and watch this happen, I can't help but think, "Wow, in 3-4 years time, that person will be able to cut your sclera open and blast you with a ruby laser." Now, if someone were to come and tell me that those SAME OD residents couldn't do the same surgeries with that kind of 3-4 year, day in and out training? That is crazy...

Optometry school should embody more of the medical model, spend more time on systemic disease, etc. That part is hard to argue against for me. The fact that students now spend 2 years on optics, 2 years on ABV, along with the other "old optometry" model classes; this is all overkill and is time that should have been spent on learning internal medicine, heart and renal, etc. One semester of pathology, ocular anatomy, ocular phizio, that is simply not enough to understand the full scope of vision we are now aware of. Optometry school SHOULD change, but this change will only come with the requisite hope that IF we change, we will get the respect to receive the training we deserve. Thank you.

Very solid post. I can't argue with any of your points. Don't use ruby lasers anymore, though. ;-) I think what you propose would help your field, as well as patients.

 

[DILLIGAF]

Did I just put a post on SDN without being called a ****** or a Nazi? I must be dreaming....

 

[Visionary]

Did I just put a post on SDN without being called a ****** or a Nazi? I must be dreaming....

Heck, I'm sure some of my brethren would be critical of my giving even an inch to optometry. Let's see how your folks respond.

 

[Veritas23]

Did I just put a post on SDN without being called a ****** or a Nazi? I must be dreaming....

You made a post that was well thought-out, honest, and made sense... especially to an attending OMD. I'd say that merits for no flak.

On the plus-side you can bet Socal2014 is about to weigh in on your post to add to the flavor of this thread!

 

[Shnurek]

DILLIGAF, we should sticky your post.

 

[IndianaOD]

If anyone goes back to some of my older posts they will see that I definitely think optometry school should resemble dental school. No one is seriously saying ODs should preform procedures they were not trained to do. I simply think ODs should have the option to increase their training and scope if they would like to by completing more residency time. I loved the year I spent as a post doc resident and think all OD students should do one.

As far as the other procedures mentioned, the ODs in Oklahoma have a near spotless record. This same positive record has been shown with all of optometry's increases in scope. The AOA journal had an analysis on malpractice cases in Oklahoma and the conclusion was very positive. The error rates have not proven higher than was the established norm.

Visionary. As far as $$ goes, I think it would be a lie to say that ophthalmology's number one incentive for attacking optometry is not monetary. Medicine is the gorilla that tilted the income ladder toward procedures. Personally I think the pediatricians, family MDs, and internists have gotten hosed for quite some time.

 

[Visionary]

Visionary. As far as $$ goes, I think it would be a lie to say that ophthalmology's number one incentive for attacking optometry is not monetary. Medicine is the gorilla that tilted the income ladder toward procedures. Personally I think the pediatricians, family MDs, and internists have gotten hosed for quite some time.

Really not sure where you're getting this from. Why would organized medicine, whose largest single contingent is primary care physicians, have pushed to decrease reimbursements for office visits and shift the money to procedures? That would be cutting off our collective nose to spite our face. Makes no sense. The fact is that the shifting in reimbursements has been guided by the government (CMS), private insurance carriers, and hospitals---not physicians (though we've tried to influence it, mainly by fighting cuts). Health care practitioners, as a whole, have seen a consistent drop in revenue relative to inflation, cost of living, etc. for decades. In the nearly two years I've been in private practice, I've already seen cuts in every facet: consult fees eliminated, intravitreal injection reimbursement cut by a third, OCT imaging made a bilateral test. Blaming physicians in this way to justify for your desire to perform more procedures is simply lame.

More detailed explanation:

Even though a growing number of procedures and minor surgeries are being performed in offices and ASCs, most are (and more historically were) performed in hospitals. The hospital and insurance lobbies are much more powerful than any physician lobby. Thus, when cuts and rearrangements need to be made, they are made in ways that tend to favor the hospitals and insurance carriers, because they provide the best palm grease to the politicians. Since there are far more office visits than procedures billed, cutting reimbursement for those reduces health care expenditures (and, therefore, insurance payouts) by a large amount in one fell swoop. Shifting money toward, or more often holding cuts on, procedures benefits the hospitals (and secondarily the specialists that perform those procedures).

 

[Shnurek]

The fact is that the shifting in reimbursements has been guided by the government (CMS), private insurance carriers, and hospitals---not physicians (though we've tried to influence it, mainly by fighting cuts).

http://www.kaiserhealthnews.org/Stories/2010/October/27/AMA-center-public-integrity.aspx

 

[VA Hopeful Dr]

http://www.kaiserhealthnews.org/Stories/2010/October/27/AMA-center-public-integrity.aspx

I was just about to bring that up. There are more specialists in that group as a whole than PCPs. That's why reimbursements for office visits suck.

 

[Visionary]

http://www.kaiserhealthnews.org/Stories/2010/October/27/AMA-center-public-integrity.aspx

Interesting. Well, I stand corrected. I will say, though, that the ultimate decision still rests with the CMS, and that is not disputed by this article. Also, while the article seems to claim specialty bias, it also cites quite a bit of information to the contrary. I can't imagine that the cardiologists and radiologists were too happy with the latest realignment. Regardless, specialists have and always will have a financial advantage over primary care physicians, though I'm not going to argue that the gap isn't currently inflated.

 

[KHE]

More detailed explanation:

Even though a growing number of procedures and minor surgeries are being performed in offices and ASCs, most are (and more historically were) performed in hospitals. The hospital and insurance lobbies are much more powerful than any physician lobby. Thus, when cuts and rearrangements need to be made, they are made in ways that tend to favor the hospitals and insurance carriers, because they provide the best palm grease to the politicians. Since there are far more office visits than procedures billed, cutting reimbursement for those reduces health care expenditures (and, therefore, insurance payouts) by a large amount in one fell swoop. Shifting money toward, or more often holding cuts on, procedures benefits the hospitals (and secondarily the specialists that perform those procedures).

That doesn't seem to make much sense.

I'm not exactly an expert on hospital economics for obvious reasons but it seems to me as a semi-educated observer that hospitals and providers who are procedure heavy (ie surgeons) tend to HATE medicare because they really screw them but "office visit" providers like internal medicine and primary care guys and OPTOMETRY LIKE medicare because the reimbursement for office visits is generally palatable.

The flip side seems to be true for private insurers. They reimburse hospitals and procedures better but the screw you on office visits.

At least that's how it is around here.

I think hospitals also have generally more clout because many parts of the country have a large corporation that owns multiple hospitals within a system. As such, strength in numbers.

But even if you're small or medium sized hospital, if you're the only one around, you have a lot of clout.

We had a situation here in Connecticut a few months back where Hartford Hospital basically said they would stop taking Aetna because of horrible reimbursments.

That basically set off a public relations war which the hospital eventually won.

 

[Visionary]

That doesn't seem to make much sense.

I'm not exactly an expert on hospital economics for obvious reasons but it seems to me as a semi-educated observer that hospitals and providers who are procedure heavy (ie surgeons) tend to HATE medicare because they really screw them but "office visit" providers like internal medicine and primary care guys and OPTOMETRY LIKE medicare because the reimbursement for office visits is generally palatable.

The flip side seems to be true for private insurers. They reimburse hospitals and procedures better but the screw you on office visits.

At least that's how it is around here.

I think hospitals also have generally more clout because many parts of the country have a large corporation that owns multiple hospitals within a system. As such, strength in numbers.

But even if you're small or medium sized hospital, if you're the only one around, you have a lot of clout.

We had a situation here in Connecticut a few months back where Hartford Hospital basically said they would stop taking Aetna because of horrible reimbursments.

That basically set off a public relations war which the hospital eventually won.

Yeah, but private insurers typically reimburse relative to Medicare. There is some wiggle room and bargaining, but it's over relatively small percentages. We had a similar situation between the university physicians group and Humana, which resulted in the former just dropping the latter. Ended up hurting the university more than Humana, in my opinion.

Typically, if CMS makes a change, it's soon adopted by the private carriers. That's why, despite what many believe, we already are in a form of socialized medicine.

 

[KHE]

Yeah, but private insurers typically reimburse relative to Medicare. There is some wiggle room and bargaining, but it's over relatively small percentages. We had a similar situation between the university physicians group and Humana, which resulted in the former just dropping the latter. Ended up hurting the university more than Humana, in my opinion.

But many private insurers will try to court docs by saying that they reimburse 110% of medicare allowable or similar such things.

Typically, if CMS makes a change, it's soon adopted by the private carriers. That's why, despite what many believe, we already are in a form of socialized medicine.

That's true and what IS bad about it is that we have all the negatives of a socialized system (bureaucratic nightmares, poor reimbursements) without the positives (everyones covered.)

 

[Visionary]

But many private insurers will try to court docs by saying that they reimburse 110% of medicare allowable or similar such things.

Yeah, 10% above Medicare is better, but not great. Like I said, small percentages. Such bargaining is also starting to disappear. Carriers are calling the bluffs of the hospitals and large groups. In my example, the docs wanted an increase, and Humana wanted a cut. The university threatened to drop them, and Humana said okay. That may not happen in smaller markets, where there is no competition, if course.

That's true and what IS bad about it is that we have all the negatives of a socialized system (bureaucratic nightmares, poor reimbursements) without the positives (everyones covered.)

Truer words have never been spoken, my friend.

 

[mclem222]

I have mixed feelings about this issue. I think the truth of the matter is that it comes down to turf and spending time in training. I have a brother who is an OMD who trained for 10 years after college (4 med school, 4 residency, 2 fellowship) and I trained for 5 years (4 years optometry school, 1 year residency). I also feel there are certain things I can do and ODs arent complete idiots as some OMDs feel. I think probably most OMDs feel the way we would feel if opticians were allowed to prescribe glasses on their own. I would think WTF? Like what was my training for? Why did I spend all this time when someone else wants to do the same stuff with less training etc.. Opticians may argue "well we will do the easy rx's and if anyone is not 20/20 or with a complaint refer them to an OD or OMD". That is similar to our argument for easy procedures. I can see how they (OMDs) feel about it. If opticians could prescribe Rxs today after doing a 6 week course I would think WTF why did I spend 5 years doing that? Similar to OMDs who might think why did I spend 5 extra years in training if ODs can do similar stuff? No one wants the other professions to "pick off the easy stuff". In my heart do I think an optician could do easy refractions and be fine? Probably so. There are technicians in some offices for ODs and OMDs who do all the refractions and contact lens fittings and things are fine. Do I want them to? Hell no. Do I think ODs could do some small procedures and be just fine? Yes? Do I think there is a lot of variability in our training so not everyone should do that? yes. My bro showed me a chart note for review from Oklahoma where an OD had done a Yag and accidentally nicked some the macula and caused a central visual defect. According to him, that is unheard of and the referred OMD (retina doc) didn't want to lose the referral so he didn't say anything. I trained to do what I do, I don't want more or less. I can see why the OMDs would be upset just as we would if opticians were given more rights. Down the street from me is an oculoplastics doc who spent three years in fellowship. He gets pissed when there are OMDs who spent a 3 month "observership" and claim to be orbital surgeons. The question is do we push for the maximum? Do we respect the boundaries set by training? I am not sure of the answer to this one.

 

[Frumps]

I have mixed feelings about this issue. I think the truth of the matter is that it comes down to turf and spending time in training. I have a brother who is an OMD who trained for 10 years after college (4 med school, 4 residency, 2 fellowship) and I trained for 5 years (4 years optometry school, 1 year residency). I also feel there are certain things I can do and ODs arent complete idiots as some OMDs feel. I think probably most OMDs feel the way we would feel if opticians were allowed to prescribe glasses on their own. I would think WTF? Like what was my training for? Why did I spend all this time when someone else wants to do the same stuff with less training etc.. Opticians may argue "well we will do the easy rx's and if anyone is not 20/20 or with a complaint refer them to an OD or OMD". That is similar to our argument for easy procedures. I can see how they (OMDs) feel about it. If opticians could prescribe Rxs today after doing a 6 week course I would think WTF why did I spend 5 years doing that? Similar to OMDs who might think why did I spend 5 extra years in training if ODs can do similar stuff? No one wants the other professions to "pick off the easy stuff". In my heart do I think an optician could do easy refractions and be fine? Probably so. There are technicians in some offices for ODs and OMDs who do all the refractions and contact lens fittings and things are fine. Do I want them to? Hell no. Do I think ODs could do some small procedures and be just fine? Yes? Do I think there is a lot of variability in our training so not everyone should do that? yes. My bro showed me a chart note for review from Oklahoma where an OD had done a Yag and accidentally nicked some the macula and caused a central visual defect. According to him, that is unheard of and the referred OMD (retina doc) didn't want to lose the referral so he didn't say anything. I trained to do what I do, I don't want more or less. I can see why the OMDs would be upset just as we would if opticians were given more rights. Down the street from me is an oculoplastics doc who spent three years in fellowship. He gets pissed when there are OMDs who spent a 3 month "observership" and claim to be orbital surgeons. The question is do we push for the maximum? Do we respect the boundaries set by training? I am not sure of the answer to this one.

Great post