Ocular Disease in private optometry practice

[RTM]

Just wondering about the levels of ocular disease that the average private OD sees. Are most of you private OD's comfortable with managing glaucoma, iritis, CRVO, DM retinopathy, maculopathies, anterior seg conditions such as k ulcers, cellulitis, HSV, or ocular rosacea?
I get the sense that most OD's simply examine eyes, sell glasses and CL's, and refer out anything "out of the ordinary".

Just wondering. . .

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[chisoxwin]

Just from my personal experience at what I consider a fairly competent/successful private practice. Iritis and most anterior segment conditions are easily managed. This includes corneal ulcers, dry eye, MGB, etc. Cellulitis I might be more apt to send to an OMD because usually it requires orders for IV Abx. Glaucoma is more rare to see in private practice, although everyone is labeled as a glc suspsect which, in my opinion, is kind of ridiculous. Retinal disorders such as DM retinopathy, or ARMD are managed by us until they become complicated, i.e. neovascular, then are referred. The OMD's in my area are very OD friendly and take time to talk to us about pts. that we refer. I hope this helps. Why the question though? I see you're already an optometrist. Did you just graduate?

 

[362.04]

RTM,

What has been your experience?

 

[RTM]

I work in a federal service hospital-based optometry practice mode. I routinely manage all facets of ocular disease. ODs in our hospital are depended upon by the urgent care doctors and we even see patients in the ER. We see plenty of "routine" patients, but in our mode of practice, we are expected to be competent in all facets of eyecare. We routinely order labs and imaging, and our OD's are responsible for systemic workups of conditions such as CRVO and iritis when warranted.
I did a federal service residency and have never left. I, frankly, can't imagine any other practice mode.
The reason for the question is that I believe that the profession of optometry being held hostage by economics. I would like to think that the average OD is getting some experience with path and routinely billing medical services, but I don't know. If an OD must survive on refraction/dispensary services, then that practice mode does not give ODs the necessary experience to develop competence in pathology. One of my best friends is a local OMD, and we discuss cases all the time. He didn't magically obtain his knowledge. It is through a program of controlled mentoring IN RESIDENCY that teaches OMDs how to practice. OMDs don't learn ophthalmology in medical school. The average OD does not have that same opportunity. We have too much didactic education and not enough mentored education. I would like to see optometry change towards being the firm leader in primary eye care. Optometrists should be in the clinic, and OMDs should be in the OR. There is absolutely no reason OMDs should be seeing conjunctivitis, iritis, glaucoma, or any other clinically manageable condition. Economics, again, is the driver for this. Optomery has an image problem. We are seen by other medical providers and patients as eyeglass providers. Only optometry can change this. And not with some quirky board certification. Optometry as a profession needs to work to get optometry services included in all hospital settings. Then we need "manditory" residencies. This will not only increase our mentored education, but will shine the profession of optometry in a positive light among medical providers. The bulk of medical providers don't know the difference between the iris and the cornea, its just the colored part. There are tons of mismanaged cases that go through urgent care and ER settings. The need for optometry clinical involvement is there, and medical providers are more thrilled to have someone to consult with. I believe that every hospital should have an optometry clinic. I'd like to see refraction be only a test that allows eyecare professionals determine a patient's best vision, not a mode of practice.

Optometry is like a language. If you don't use it, you lose it.

 

[chisoxwin]

While I agree with the use it or lose if philosophy, the fact is that the cost of optometric education is just too high. Maybe more OD's would do residencies or work in the modes you have suggested if they didn't have so many educational loans to pay. An optometric education costs just as much as a medical education in many instances with the potential to make only half as much money...and that's if you're doing well right out of school. I also agree that board certification will not solve any of this. In fact, it will likely create more problems than it solves.

 

[RTM]

Maybe it is the cost of our education that is at the root of our profession's problems! I have to agree that optometry school is way too expensive. I came out of school with 140K of debt. If there are any students reading this thread, there are federal loan repayment programs available. I had my loans forgiven. It took me 7 yrs of federal service to complete it, but my loans are gone. Check it out before you feel forced to sign on the dotted line at pearle.

Is a private practice dispensary really that profitable to skew practice modes that much? Does private practice get pretty routine? I hate the thought of seeing myopes all day. When I worked at a private practice as a student, I often thought, "What am I doing? This is mind-numbing!" At least at the practice I spent a short time at, it seemed like it was the same thing day after day. . . glasses, contact lenses, and the occasional HVF thrown in. The doc spent an average of 20 mins per patient.

Since I have not been in private practice I don't have a good read on the advantages of adding the pathology component to private optometry, but I can tell you this. . . The insurance companies are moving in the direction of medical care services being the only reimbursible services. Hence, the kooky optometry board certification process. Optometry as a profession wants to repackage the same old optometry services into a shiny new board certified box and expect that no one will notice? Hmmm. If insurance reinbursement moves in a direction of pay for performance or keeping RVU scores, optometry is in real trouble. It seems that the only services that continue to be valued in the eyes of insurers is medical services. I'd like to see optometry as a profession gearing up to prepare its new grads for medical optometry practice through a more mentored education. We get all this pathology education, but I get the feeling that less than half of that education is utilized in most optometry practice modes. I struggled to get through all that, there was no way I wanted to lose it. I see our profession as a whole, losing it.

Additionally, if optometry could meaningfully expand its scope, I think we'd see less career disappointment. Again, I don't know for sure, but it seems that the picture painted in op school of what great "Doctors" were all going to be somehow doesn't measure up when some of us are financially forced to refract all day at pearle vision.

I have also heard some of my classmates say they chose optometry because its easy. Maybe some of our collegues simply aim low.

I guess my punchline here is that I feel like there are some scenarios in which optometry could be in real financial trouble unless we conform to the medical model.

Dunno. Let me know what you think.

 

[KHE]

Just wondering about the levels of ocular disease that the average private OD sees. Are most of you private OD's comfortable with managing glaucoma, iritis, CRVO, DM retinopathy, maculopathies, anterior seg conditions such as k ulcers, cellulitis, HSV, or ocular rosacea?
I get the sense that most OD's simply examine eyes, sell glasses and CL's, and refer out anything "out of the ordinary".

Just wondering. . .

I am in private practice and I see and manage all of those conditions. Almost certainly, I see less "pathology" than what would be seen in a VA clinic but that's to be expected. The VA is at the end of the day a hospital. Most optometry in the VA is done in the context of an outpatient clinic but it's still a hospital environment.

I mean seriously...what's so complicated about managing a CRVO or a corneal ulcer?

 

[KHE]

Maybe it is the cost of our education that is at the root of our profession's problems! I have to agree that optometry school is way too expensive. I came out of school with 140K of debt. If there are any students reading this thread, there are federal loan repayment programs available. I had my loans forgiven. It took me 7 yrs of federal service to complete it, but my loans are gone. Check it out before you feel forced to sign on the dotted line at pearle.

I had more than the average loan and I paid it off in about 7 years without any federal service.

Is a private practice dispensary really that profitable to skew practice modes that much? Does private practice get pretty routine? I hate the thought of seeing myopes all day. When I worked at a private practice as a student, I often thought, "What am I doing? This is mind-numbing!" At least at the practice I spent a short time at, it seemed like it was the same thing day after day. . . glasses, contact lenses, and the occasional HVF thrown in. The doc spent an average of 20 mins per patient.

Private practice can get routine but so can any mode of practice. To me, the VA would be the worst mode of practice. Nothing but an endless stream of grizzled old men with cataracts, mac degen, and diabetic disease. *snooze* It might be slightly better now that we got an actual war going on, perhaps there are younger veterans and maybe even a few females, but most of my experience with the VA, and that of my wife who has way more VA experience than I do is just that....grizzled old men with cats, mac degen, and diabetic ret.

Hmmm. If insurance reinbursement moves in a direction of pay for performance or keeping RVU scores, optometry is in real trouble. It seems that the only services that continue to be valued in the eyes of insurers is medical services. I'd like to see optometry as a profession gearing up to prepare its new grads for medical optometry practice through a more mentored education. We get all this pathology education, but I get the feeling that less than half of that education is utilized in most optometry practice modes. I struggled to get through all that, there was no way I wanted to lose it. I see our profession as a whole, losing it.

Additionally, if optometry could meaningfully expand its scope, I think we'd see less career disappointment. Again, I don't know for sure, but it seems that the picture painted in op school of what great "Doctors" were all going to be somehow doesn't measure up when some of us are financially forced to refract all day at pearle vision.

I don't agree that scope expansion is necessary for fulfillment. Maybe for some, but those people probably should have become ophthalmologists in the first place. At the end of the day, I make a lot more money than most physicians working in a clean, comfortable, low stress environment helping people see better. Doesn't get much sweeter than that.

I have also heard some of my classmates say they chose optometry because its easy. Maybe some of our collegues simply aim low.

Respectfully, those classmates of yours are ******ed.

 

[KHE]

I would like to see optometry change towards being the firm leader in primary eye care. Optometrists should be in the clinic, and OMDs should be in the OR.

What is "primary eye care?" I've never understood that. That's a term coined by optometrists, and used exclusively by optometrists. Most optometrists use it to mean "anything other than surgery." Well, ok....but I don't think anyone would argue that a patient with severe non proliferative retinopathy in one eye and NAION in the other is a "primary care" patient.

There is absolutely no reason OMDs should be seeing conjunctivitis, iritis, glaucoma, or any other clinically manageable condition. Economics, again, is the driver for this. Optomery has an image problem. We are seen by other medical providers and patients as eyeglass providers. Only optometry can change this. And not with some quirky board certification. Optometry as a profession needs to work to get optometry services included in all hospital settings. Then we need "manditory" residencies. This will not only increase our mentored education, but will shine the profession of optometry in a positive light among medical providers.

While having optometry included in hospital settings is fine and dandy, the "image problem" you speak of will not be helped unless optometry interacts in a meaningful way with other medical disciplines, not just "doing eye exams at the hospital."

The bulk of medical providers don't know the difference between the iris and the cornea, its just the colored part. There are tons of mismanaged cases that go through urgent care and ER settings. The need for optometry clinical involvement is there, and medical providers are more thrilled to have someone to consult with. I believe that every hospital should have an optometry clinic.

Most hospitals don't even have an ophthalmology clinic. How much demand is there for "optometry services" in the average community hospital?

 

[RTM]

I appreciate other's views. By the way, I do not work in a VA or in the military. My age range is from month of age to over 100 yrs. And I do not see old men all day, but that's besides the question.

Some of what I'm trying to say is that those ODs who are not having the career they envisioned may be helped by really expanding the scope of optometry.

As far as hospital optometry, IMHO, it is the most comprehensive mode of optometry practice. When I speak of interaction with medicine, I mean internal medicine, family medicine, peds, urgent care, etc. These are the places that need optometry's help. . . Not your local OMD. I do believe that best way to increase optometry's interaction with medicine in any meaningful way is by having OD in hospitals. A private practice on 1st and Elm or working at pearle isn't going to increase that interaction. Not having opthalmology in hospitals is exactly the point!

I am not trying to berate private practice or even corporate practice. If those doing it are happy, they're not going to listen to me anyway. It is just my opinion that optometry would be served well by meaningfully expanding its scope. That doesn't mean everybody has to practice full scope, but I think insurers will have some flaming hoops for us to jump through in the future. I think insurers are looking to trim some fat in the coming years and private/corporate optometry may be looking a little porky. Also, if Obama's vision of nationalized healthcare comes to be, optometry has an opportunity to really gain. But only if we as a profession can perform in the role of a hospital-based specialty. There is a long track record of federal entites utililzing optometry heavily.

 

[362.04]

I work in a federal service hospital-based optometry practice mode..

I have worked in a county hospital's ophthalmology clinic in quite the role you mentioned. For two days of the week, I covered their emergency room and was their first call. I asked them to call other providers only if there was a gun shot involved.

I thus saw blunt trauma, MVA, acute corneal injuries, acute glaucomas, I believe that the predoctoral training that most optometrists obtain is probably suitable for this work. I did not do a residency and was able to do quite nicely in this environment so a residency is not an absolute requirement for such a position.

I concur with RTM's view that optometry should be in every county and federal hospital. I think it is a bit hard to exist in private hospitals, though where the political forces are a bit more heightened. I still have associate privileges at this hospital even as I have left.

 

[aphistis]

While I agree with the use it or lose if philosophy, the fact is that the cost of optometric education is just too high. Maybe more OD's would do residencies or work in the modes you have suggested if they didn't have so many educational loans to pay. An optometric education costs just as much as a medical education in many instances with the potential to make only half as much money...and that's if you're doing well right out of school. I also agree that board certification will not solve any of this. In fact, it will likely create more problems than it solves.

This doesn't make sense. You're saying that in some circumstances an OD costs as much as an MD, so optometrists can't afford to spend time in residency. That sounds good until you look at the argument from the other side--i.e., almost all MD's cost at least as much as an OD, yet nearly every single new physician in America completes residency without going broke.

Earning potential after residency doesn't influence your ability to pay the bills during residency.

 

[362.04]

"...This doesn't make sense..."

That is because you don't understand optometry

 

[RTM]

My understanding of chisxowin's comment is that impending debt after graduation forces some to choose a mode of practice based on monetary considerations rather than practice mode preferences.

Many federal service positions which include residencies and heavy path patient loads can be lower paying. Heck, I do not make as much as the typical OD with a successful dispensary or the guy at pearle, but I also live in a lower cost of living area and its all a wash.

I don't understand aphistis' comment about who is cheaper ODs or MDs.
If you're talking about cost of schooling, schooling is about the same, but the earning potential is less for an OD. The reason MDs spend time is residency is because they have to. THAT'S WHERE THEY LEARN EVERYTHING ABOUT HOW TO PRACTICE MEDICNE. Also, since they have to, medical residencies pay better.

If you're talking about cost to a hospital, the clear answer is ODs. I get paid half as much as our hospital OMD and about 2/3 as much as our average MD. Deservedly so, I might add. I am not debating that MDs spend more time and some long nights at the hospital. I finish my patients, go home, and don't think about patients unless I'm on call. Only rarely do I have to come in at night. Usually its on a weekend day for the urgent care clinic. So I have no beef about $.

Earning potential after residency certainly does influence ability to pay bills during residency and for the remainder of your career! I can see the logic of a person having a large debt load opting for making as much money as they can as early as they can. For many this eliminates residency as an option, even if they are interested.

Also, I have to add that doing a residency opens many oportunity doors for those who complete them.

 

[aphistis]

That is because you don't understand optometry

I understand earning an expensive professional degree and going through residency afterwards.

 

[RTM]

I understand earning an expensive professional degree and going through residency afterwards.

This may be true and I commend those efforts. But not everyone has the same financial considerations. I also suspect that your earning potential after residency was higher than that of an OD.

 

[aphistis]

This may be true and I commend those efforts. But not everyone has the same financial considerations. I also suspect that your earning potential after residency was higher than that of an OD.

Fair enough. I can agree to disagree.

 

[362.04]

I understand earning an expensive professional degree and going through residency afterwards.

But you are evaluating optometry from a dentist's perspective. Therefore your comments must be taken in that light and not necessarily helpful to the audience within this forum.

BTW, why do you post or lurk on this forum?

 

[RTM]

I understand earning an expensive professional degree and going through residency afterwards.

I think this discussion is good.

I believe that economics is a strong driver for optometry in the sense that it guides some in our profession away from optometry, residency, and primary eyecare and towards opticianry (sp?).

Herein lies one of my central themes. I believe that most (notice I did not say all) clinical knowledge comes from the mentored portion of our education. I'd be interested to hear comments relating to how much you feel your overall knowledge and practice methods were obtained from that mentored education vs. your didactic education? Even those ODs who did not do a residency can comment on how much help the last year of clinical rotations contributed to their clinical education. For myself, I can say that clinical student rotations and residency were HUGE factors on my clinical knowledge base, overall clinical competence, and practice methods.

Secondly, I really think that frequency of pathology makes us more apt to pick up the subtle findings that can make the difference between early diagnosis, later diagnosis, or missing something completely. Pathology is like anything else, the more you do it, the better you get at it. This notion leads me to another point. If optometry does not put itself in a better position to frequently manage a full array of ocular disease states, how do we purport to maintain competency? Competency is such a buzz word nowadays.

Lastly, the future of optometric eyecare should be blend of refractive services and medical services. One does not trump or outweigh the other, they are both equally important. From my perspective, it seems that economics is leading optometry more toward refractive services because it is profitable. I don't have a crystal ball, but I see the future of healthcare reimbursement focusing heavily on medical services for determinations of value from any given specialty. I think that optometry needs to prepare new grads for this potential shift in healthcare. I think optometry should be a larger part of the overall eyecare of everyone. Only by working with ophthalmology can we begin to solve one of the basic problems in eyecare. . . Access to care.

Like it or not, medicine and ophthalmology hold a lot of influence on any issue that relates to optometry and its scope. The only way medicine and ophthalmology will ever consider working together is through efforts within optometry to increase our education and clinical competence. Optometry can talk a good game with all this board certification, but increasing our mentored education, gaining access to medical practice modalities, and showing our competence clinically will be a thousand times better.

 

[KHE]

There's so much in this posting that I completely disagree with.

I think this discussion is good.

I believe that economics is a strong driver for optometry in the sense that it guides some in our profession away from optometry, residency, and primary eyecare and towards opticianry (sp?).

There's that term again....primary eye care. WTF is that?

Herein lies one of my central themes. I believe that most (notice I did not say all) clinical knowledge comes from the mentored portion of our education. I'd be interested to hear comments relating to how much you feel your overall knowledge and practice methods were obtained from that mentored education vs. your didactic education? Even those ODs who did not do a residency can comment on how much help the last year of clinical rotations contributed to their clinical education. For myself, I can say that clinical student rotations and residency were HUGE factors on my clinical knowledge base, overall clinical competence, and practice methods.

To me, this seems like it's just stating the obvious. Any profession or skill set, whether it's clinical sciences, auto mechanics, or figure skating can only be learned by "doing." You can read all the books in the world on refraction, gonioscopy, engine rebuilds, or triple salchows but unless you actually get out there and start DOING refractions, gonioscopies, engine rebuilds, or triple salchows, you're not going to get good at any of those things. I'm not really sure what your point is with the above paragraph.

Secondly, I really think that frequency of pathology makes us more apt to pick up the subtle findings that can make the difference between early diagnosis, later diagnosis, or missing something completely. Pathology is like anything else, the more you do it, the better you get at it. This notion leads me to another point. If optometry does not put itself in a better position to frequently manage a full array of ocular disease states, how do we purport to maintain competency? Competency is such a buzz word nowadays.

The tacit implication in that paragraph is that optometry is not currently doing a good job of "managing a full array of ocular disease states." Well, I would point out that there isn't a whole stack of people piled up in the streets who have been blinded by renegade ODs. What is "competency" in any given situation anyways? For example, I think it's safe to say that every OD out there should be able to recognize and manage conjunctivitis. However, it's probably not necessary for an OD to be able to recognize and manage idiopathic polypoidal choroidopathy. In that case, all they have to be able to do is detect it and refer it to someone more capable.

Lastly, the future of optometric eyecare should be blend of refractive services and medical services. One does not trump or outweigh the other, they are both equally important. From my perspective, it seems that economics is leading optometry more toward refractive services because it is profitable.

This I absolutely disagree with. I think optometry has already always been doing "refractive services" and making money at it. I believe that optometry is moving more into medical services while retaining the refractive.

I don't have a crystal ball, but I see the future of healthcare reimbursement focusing heavily on medical services for determinations of value from any given specialty. I think that optometry needs to prepare new grads for this potential shift in healthcare. I think optometry should be a larger part of the overall eyecare of everyone. Only by working with ophthalmology can we begin to solve one of the basic problems in eyecare. . . Access to care.

Healthcare already focuses heavily on medical services. Refractive services aren't covered by most major medical plans or medicare. I also strongly disagree that access to eyecare is a problem. I defy anyone on here to point out any place in the United States where one can not get an eye exam within in day and within an hour's drive.

Like it or not, medicine and ophthalmology hold a lot of influence on any issue that relates to optometry and its scope. The only way medicine and ophthalmology will ever consider working together is through efforts within optometry to increase our education and clinical competence.

I don't agree with that either. We already have the education and the clinical competence. The problem is that every medical specialty other than ophthalmology simply never sees it because in medical school and residency, the overwhelming majority of physicians are drilled that if there is anything wrong with an eyeball other than a need for glasses, then they damn well better refer that patient to an MD ophthalmologist or else they (the PCP) will be sued up the wazzoo.

Optometry can talk a good game with all this board certification, but increasing our mentored education, gaining access to medical practice modalities, and showing our competence clinically will be a thousand times better.

This I sort of agree with. The key to fixing this problem is to have optometry STUDENTS working alongside with medical STUDENTS and RESIDENTS.

 

[blazenmadison]

This I sort of agree with. The key to fixing this problem is to have optometry STUDENTS working alongside with medical STUDENTS and RESIDENTS.

I'm currently externing at a VA hospital with med students/residents. I have to constantly remind/inform med students, residents, AND physicians that optometrists do dilated examinations, have 8 yrs of college background, and optional residencies. I have gotten the "optometry school..that's right after high school?." Or some think optometry=ophthalmology.

Maybe this "I am a board certified optometrist in refraction" thing will wow those in the medical field but probably not.

 

[aphistis]

But you are evaluating optometry from a dentist's perspective. Therefore your comments must be taken in that light and not necessarily helpful to the audience within this forum.

BTW, why do you post or lurk on this forum?

Shrug. Like I said, it's your prerogative to dismiss my opinions if you want. My feelings aren't hurt.

To answer your question, however--as a fellow non-physician healthcare provider, I find the discussions here interesting. Plus, see that blue suitcase under my picture? I watch for problems throughout the site, not just in the dental forums. Have a nice day.

 

[RTM]

Wow. My view of optometry is not one practice modality fits all.

I view primary eyecare as eyecare given in the clinic.

I believe that the current state of optometric practice is not in a position to manage a wide variety of ocular conditions, and I do think that limits the average ODs competence when it comes to ocular pathology.

There are plenty of places were access to eyecare is a major problem.

The reason we are not seen as competent by many medical docs is because we have not been in a position (like working with other medical specialities in a hospital) to show our competence.

I think some things need to change in optometry and many of the issues that I believe need to be addressed can be addressed through more mentored optometric edcuation and a shift if what is seen a appropriate practice modalities for optometry. Yeah, I'm pro-residency. Its my opinion. Residency is a virtual requirement in medicine, I think optometry should consider increasing availability of residencies for optometry. Its also my opinion that optometry should be in hospitals.


I started this thread to hear others' ideas and opinions not to endure an invalid point by point critique of mine.

 

[362.04]

Shrug. Like I said, it's your prerogative to dismiss my opinions if you want. My feelings aren't hurt.

To answer your question, however--as a fellow non-physician healthcare provider, I find the discussions here interesting.

Thanks for the clarification.

I am just a bit skeptical about other specialties telling how ODs should feel. Dental income is about 2-3x to ODs and the loan problems is now even a bigger issue.

 

[chisoxwin]

My understanding of chisxowin's comment is that impending debt after graduation forces some to choose a mode of practice based on monetary considerations rather than practice mode preferences.

Sorry for the confusion. That's what I meant to say. Doing a residency doesn't necessarily guarantee any higher salary or better mode of practice. Therefore, with that much debt lurking, a lot of optom students opt out of it to start making money and paying down loans.

 

[KHE]

I started this thread to hear others' ideas and opinions not to endure an invalid point by point critique of mine.

What's invalid about what I've said?

You've made a number of broad statements about what optometry "needs" or "should be doing" yet you yourself admit that you did a residency in the "federal system" and never left. (You had mentioned that you are not at the VA. In that case, I'm going to assume you're at IHS. If that's not the case, please correct me.)

And while optometry's participation in the "federal system" is slowly growing over time, (the federal government is after all the largest growth sector of the economy today...why should ODs be left out) ODs working for the government still represent a tiny fraction of the total number of practicing ODs.

So I guess what I'm wondering is this....

On what basis does someone who has never worked as a doctor in any environment other than one in which only a tiny fraction of ODs participate in have an adequate frame of reference for what optometry "needs" or "should be doing?"

 

[KHE]

Sorry for the confusion. That's what I meant to say. Doing a residency doesn't necessarily guarantee any higher salary or better mode of practice. Therefore, with that much debt lurking, a lot of optom students opt out of it to start making money and paying down loans.

Terrible idea....I did a residency and as I've stated many times before, that residency allows me to keep patients in my practice longer than had I not done that residency. That has translated into a lot more money over time than the difference in what I would have made my first year out.

 

[chisoxwin]

Terrible idea....I did a residency and as I've stated many times before, that residency allows me to keep patients in my practice longer than had I not done that residency. That has translated into a lot more money over time than the difference in what I would have made my first year out.

Look, I don't come on here and say your ideas are terrible just because I might disagree with them. That's great that your residency has allowed you to keep patients in your practice longer, but please read my post as I wrote it...that is, does not necessarily "guarantee" a higher salary. While it may have worked for you, the point is that not all optometry students think this way.

 

[KHE]

Look, I don't come on here and say your ideas are terrible just because I might disagree with them. That's great that your residency has allowed you to keep patients in your practice longer, but please read my post as I wrote it...that is, does not necessarily "guarantee" a higher salary. While it may have worked for you, the point is that not all optometry students think this way.

There may be many reasons why someone does or does not do an optometric residency but some sort of need to quickly get out there to pay down student loans should NOT be a reason to not do one.

 

[aphistis]

Terrible idea....I did a residency and as I've stated many times before, that residency allows me to keep patients in my practice longer than had I not done that residency. That has translated into a lot more money over time than the difference in what I would have made my first year out.

There may be many reasons why someone does or does not do an optometric residency but some sort of need to quickly get out there to pay down student loans should NOT be a reason to not do one.

Ignorant & ill-informed or not, KHE, I agree 102% with both of these posts.

 

[chisoxwin]

There may be many reasons why someone does or does not do an optometric residency but some sort of need to quickly get out there to pay down student loans should NOT be a reason to not do one.

I agree 100% that this should not be a reason. All I am saying is that for some in my class it was a reason. I am not at all advocating this approach.

 

[chisoxwin]

And FWIW, I'd rather see a required residency program than a board cert. process. I think that the extra training would give us more credibility. Please don't read any of my posts as derogatory about doing a residency. I was simply trying to speculate (and spout from my own experience with classmates) why some that originally thought about doing residencies went straight into practice...often times into corporate practice. Therefore these people don't practice as the OP does. Have a good one guys...going out of town for the weekend

 

[RTM]

And FWIW, I'd rather see a required residency program than a board cert. process. I think that the extra training would give us more credibility. Please don't read any of my posts as derogatory about doing a residency. I was simply trying to speculate (and spout from my own experience with classmates) why some that originally thought about doing residencies went straight into practice...often times into corporate practice. Therefore these people don't practice as the OP does. Have a good one guys...going out of town for the weekend

I agree 100% that required residency is much better than required board certification.

 

[RTM]

How is my mode of practice relevant? I have just as much perspective when it comes to optometry as anyone. My statements are broad by design. I certainly do not have all the answers, nor do I pretend to.

I'll say it again, required residency is much better for our profession than some hokey board certification process. What a joke.

And. . . Optometry should broaden its practice scope. We should, IMO, be in hospitals. Everwhere. Is it possible? I don't know, but I do think it would be beneficial. There is always resistance to change. That change cannot happen immediately, but I believe we as a profession should take all the positive things that optometry has gained in hospitals and move that into other facets of optometry care. I am not trying to fundamentally change optometry, but a change of practice location may help the profession prosper.

 

[362.04]

RTM,

The practice of optometry in hospitals is one of the chicken vs egg problem.

In my opinion, until optometrists start bona fide general medical clinical rotations of at least 2-8 week sessions in their 3rd or 4th year, there will be significant lack of momentum to support the practice of optometry in hospitals.

Therefore, predoctoral education across the board needs to be modified.

 

[RTM]

I do think that is an excellent point that pre-doctoral eduation needs to be changed as well.
If we want to be treated as medical specialists in the capacity that optometry is competent to do so, our education needs to mirror that of other specialities.

College requirements-->Op school-->residency options-->Hospital practice options

I'm certainly not saying that optometry should not embrace other practice modalities. I just see advantages of expanding this track.

 

[KHE]

How is my mode of practice relevant? I have just as much perspective when it comes to optometry as anyone. My statements are broad by design. I certainly do not have all the answers, nor do I pretend to.

It matters because the needs, goals, and perspectives of someone in your situation are likely going to be a lot different than the needs, goals and perspectives of people who embark on the two traditional optometric career paths...commerical and private clinical practice.

 

[dragon1761]

Just wondering about the levels of ocular disease that the average private OD sees. Are most of you private OD's comfortable with managing glaucoma, iritis, CRVO, DM retinopathy, maculopathies, anterior seg conditions such as k ulcers, cellulitis, HSV, or ocular rosacea?
I get the sense that most OD's simply examine eyes, sell glasses and CL's, and refer out anything "out of the ordinary".

Just wondering. . .

it really depends on which state you practice in.