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.