OD respect?

[abs1]

Well, I think its pretty obvious that one of the reasons that ODs would like to do surgery is because it would bring in a higher income. Heck, the reason some people chose MD over OD is for that very reason. But does everyone who goes to MD school do it for the $$? Of course not. Then maybe, just maybe, all the ODs that want to do some refractive surgery someday dont just want to do if for the $$? Of course $$ is an issue. It is an issue for everyone. I agree with you there. But its not always the ONLY issue.

I dont agree that people go into optometry to avoid managed care. Well maybe they do?? But if they do, they will be sad to see that optometry is very much a part of managed care and will only become more and more involved in it. But thats just a minor point.

And you are right that many pre-ODs go into the field because it allows more "personal" time outside of work. But I would argue that the reasons you go into a profession are not always the same as why you enjoy it once you are in it. Expanding their profession's scope of practice to an exciting new area just might outweigh many ODs love of "personal" time?

So, I do partially agree with you. Id say there are three main reasons that ODs want to perform LASIK (in no particular order): 1. Its very profitable 2. Its very interesting 3. ODs, like MDs, want to deliver the best eyecare they can to their pts. You see, ODs know the little "secret" that LASIK is, in fact, an easy procedure. Thats the prob. ODs know they can do it, and MDs know they can to. Noone likes being told that they cant do something that they know they can. So ODs will fight for what they feel they KNOW THEY ARE CAPABLE OF. And EYEMDs are scared sh&*%less of them too, as is evident by EYEMDs many attempts to squash the ODs. Its as simple as that.

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[Jubileee]

If anyone thinks optometry is not already affected by managed care, they are in for a big shock.

Most optometrists are dealing with this now. Hmm..Do I want to be in plan x. I currently can charge $65 for an exam and they only reimburse me for $40. Then again is has the potential to completely fill up my books..(make it up in volume)...Then there is also the people who will ONLY deal with those who are providers..

If they have a dispensary then it is even more involved in their day to day..Ok...I have a lagy here who wants progressive lenses. Normal charge for basic plastic is $189, Insurance will reimburse for $95. Upgrade to poly lenses, normal $50 discount $20. Frame $140, Insurance will pay $60 and patient will make up difference less 20% discount..

So now what would have been a $379 sale is one that is now $239, of which you only get $84 of it upfront. This is actually one of the more common plans I am basing it off of...

I work for one of the "evil empires" and we do at 40% of our work with managed care plans now. The doctor's offices I have worked at deals with at least that same amount as well...

So to say we might end up having to deal with it, is well.. A little too late..

But I do think this is one reason why Optometrists are interested in doing things such as Lasik..Something that can increase profitability for their practice.

Cassandra

 

[puffy1]

My personal feeling is that no surgical procedure, no matter how "easy" it may be technically and in theory, is really easy when every factor is involved (side effects, complications, etc.). So many things can go wrong during a surgical procedure...to say it's "easy" is underestimating it. It's kind of like Goliath looking at David and thinking to himself, "Boy, this should be easy...".

abs1: Good, mature response to my post...however, I did emphasize that money, while a big reason, isn't the only reason why ODs would want to expand the scope of their profession. And I don't believe OMDs are trying to squash their OD colleagues...you have to look at it this way. If I felt that you were trying to invade my "turf", I'd be defensive and do everything I can to protect it...and if you were trying to claim what you believed to be rightfully yours, you would do everything you could to claim it.

If OMDs tried to prevent ODs from performing eye exams, you would do everything in your power to prevent that, wouldn't you? I know this sounds a bit unrealistic, but I think you get my point.

And while HMO's have infiltrated the field of optometry, the profession, for the most part (I believe) is still a cash-and-carry system. If you think it's bad now, just imagine if surgery became a full part of your profession. And let's not even mention how much your malpractice insurance would increase...

Let me ask y'all this question...if ODs were allowed to perform LASIK and other "easy" surgical procedures, would any of you be willing to undergo, say, a two-or-three year residency program right after optometry school? Or do you think it's even necessary for that much training in the first place?

Peace.

 

[cpw]

I don't think I'd want to do Lasik even if it was available to me. Surgery doesn't interest me and was one of the reason I went for optometry in the first place. I think there should be a one or two (maybe even three) year residency or EXTENSIVE CE program or requirement before OD's even think of performing surgeries. Granted, we go through some laser training here at UHCO, but I haven't gotten to that program yet, so I don't know the full scope of the training.

I think if you do start performing surgery, you're correct the malpratice insurance would sky rocket. There would also be the cost of the lasers, larger practices, etc. It would be EXTREMELY expensive to start up. And then if it does happen, you'd still have the OMD vs OD debate.. how many patients would go to an OD (no matter how expert and qualified they were ) when they could go to an MD x-number of years of residency trained "eye surgeon". I think we'd be at a disadvantage.

I have a feeling I'm going to enjoy primary care. And, as for the insurance managed care debate. In the private pracice I worked in out of the 15-18 patients we saw per day... I only remember ONE per day paying cash. The rest were almost ALL VSP. I think the only other major insurance I saw was Medical Eye Services. I think the Dr's I worked for were on more than twelve plans too. VSP dominated the market (at least in northern california) and most of this part of Texas from what I've seen. They reimbursed more than most plans too, from what I've seen. There were many plans our OD's were being courted by to sign up for and they just paid pitiful amounts per exam.
And almost nothing for materials. (frames/lenses)

 

[puffy1]

I had no idea how much insurance companies have had an effect on optometry.

cpw, you hit the nail on the head about a lot of things...cost, desire, etc. I think those who do want to do surgery are in the minority. Many opts still do it because they want to help people, they are fascinated with the eye, and they want to live a semi-normal life outside of work. The money ain't bad either, but then again none of us future health professionals do it for the money...

 

[Ballew21]

Hey Cassandra, how are you? ) If someone thinks that going into optometry will spare them from managed care is sorely mistaken. In most practices, the practice that I work for included, at least 40% of the patients have some sort of vision plan which entices them to visit your office. (I think I pulled that figure from Optometric Management.) It has become a necessary evil really, and it's something which anyone going into medicine has to accept.

This brings up a question that I have for those who are in optometry school though; When you went to interview at your respective schools, did any of the interviewers ask your opinion of corporate optometry and managed care? From what I heard, IU doesn't usually ask anything in that area, but I didn't know if that was the case at other schools.

Thanks,
Nick

 

[mpp]

I interviewed at SUNY and Pacific and at neither school were those topics brought up. However, both interviews asked questions about what I see myself doing some time in the future. I think the question at Pacific's interview was "What would be your ideal practice setting?"

 

[Thewonderer]

Like many posters (OD and OMD) have said, the way different health care professionals work together have been great for the patients so far. If this is true, then why do optometrists want to expand their fields and take away OMD's turfs? Most likely due to $$$.

There is truly no right and wrong answer to it. It all depends on whether you are an MD or an OD. MD's want to protect their territories and OD's want to protect theirs as well. And one of the previous posters made a good point. If OMD's decide to invade OD's turfs and become the sole persons capable of prescribing glasses and taking over all the primary care eye services, how would OD's react? no less vehemently than how OMD's are reacting now.

Another thing..... OD's feel that their training prepares them much more than what they are allowed to do under the LAW. Well, it sucks but that's the law. This is called reality. I mean, anyone with slight intelligence (3.0 college GPA) if forced to undergo 4 years of basic medical training (suppose somebody decided to create a separate "MD" degree program) can probably do what a GP can do. They are "qualified" (according to OD's argument). But should they actually practice primary care just like GP's??? Maybe. maybe not. But if the law says they can't, then they won't be allowed to. This is like the situation of PA's and NP's. PA's and NP's want to practice "medicine" independently of MD's. But if PA's, NP's and OD's all get their wishes, then before we know, everybody can just set up whatever training programs they want to get a piece of the MD's pie! This will be a mess and disaster!!

Therefore, the bottomline of my argument is that yeah, it sucks that you go through all these trainings but are only allowed to do so little for your patients. But that's the way how world works. Because without the laws, anybody can take over other people's jobs with the "appropriate" training. And government regulations are there because 1) due to the lobbist's power and 2) to protect the patients.

Another flip side of the argument. If OD's truly really feel that their training is too good for what they can do, then why don't we pass a law to limit the number of years you have to go through OD schools. Let's cut it down to 2 years and save all of you some time, so ultimately your training and what you can do will be proportional. In some countries, optometry is a 2-year program at a technical school after you graduate from HIGHSCHOOL. In this country, you need a BA first and for what you can do, that's ridiculous, isn't it? So why don't we revamp the training system for optometrists?

Anyway, some random thoughts.....

 

[TomOD]

Ahhhhh, I really hesitate to get into all of this.

There are very valid reasons that OD's have expanded their scope of practice over the years. Originally what would happen went something like this: An OD would have a patient come in with what was obviously a corneal abrasion. He would have to say to the patient, "Ms. Jones, what you have is a corneal abrasion. You need a topical antibiotic soln. qid OD x 10 days, a cycloplegic and a pressure patch overnight......but I can't do that for you. You will need to call an ophthalmologist (or your family doctor or his nurse) and if your lucky you can get an appointment in 3 or 4 weeks (and pay again).

It was unfair to the patient, inconvenient to the patient and just plain silly. OD's have shown over the past 25 years that they are JUST AS QUALIFIED to treat most non-surgical (and some minor surgical) cases. I do it daily....from glaucoma, corneal and conjunctival FB's, simple red eyes, no-so simple red eyes (Uveitis) etc. Some OMD's, years ago wrote article after article about how OD's (like me) would KILL patient's if we were allow to use dilating drops!! I am happy to say I use topical and oral meds everyday and have not killed anyone yet. AND I don't know of any OD's that have. It is 100% politcal and the only one complaining are a few OMD's who are not confident in their skills. If you good, you don't have to worry about what everybody else is doing.

There was an article on t.v. a few weeks ago about a guy who faked being an M.D. for 20 or 30 years. He was a pharmacist by trade and studied medical books and did pretty well for all those years until he got caught. His patients thought he was great. I work with 2 PA's that run their own clinic. They do pretty well. My point is that medical schools, as arrogant as they are, don't have a monopoly on education.

As far a education is concerned. I would contend that OMD's are WAY overtrained for what they do. They waste their time in medical school learning basic medicine. NO ophthalmologist does anything except treat eyes. They are not setting broken bones or treat ear infections. After med school they begin to learn about the eyes (for 3-4 years). We do it for 4 years.

 

[TomOD]

In 20 years (if not sooner), there will be no more "general ophthalmologist". The successful ones today have all realized that they can not or should not try to compete will OD's. They have become secondary and teritary care providers and have make alot of money doing so.

If one of my pt.s needs caratact surgery. He goes out to one of our "cataract cowboys" who does a 10 minute cataract procedure with PCIOL's and gets $600 from medicare and I get the patient back and $150 for post-op care.

If the patient has a macular hemmorhage, he goes to our only vitreal/retinal guy in the area. He treats him the best he can (usually just prevents him from going more blind at best) and sends the patient back to me to explain to him why he is going blind.

If the patient has glaucoma......I diagnose and treat it. If he doesn't respond to topicals, I send him to our glaucoma surgeon who takes about 25 seconds to "laser" a peripheral iridotomy. The patient then comes back to me for visual fields and IOP's routinely.

I VERY rarely (read that never) send a patient to a general OMD. I don't need to. We actually only have 2 or 3 and they are very old and very anti-optometry. They decide, long ago to hate OD's and they are slowing fading away. The OMD's that befriended OD's (to get surgical referals) have prospered greatly. They KNOW their role.......as secondary and tertiary care providers (and as MY surgical technician).

P.S. This OMD/OD referral center put in a dispenary to sell glasses about 5 years ago when they realized how profitable it is.....much to the dismay of many OD's referring pts. there.

There is a blurring of the lines and no doubt there is no longer room for the GENERAL OPHTHALMOLOGIST. They are going the way of the dinosaur......like it or not.

 

[UWSO2003]

Hi Tom,

Hear hear ..... I'll throw in a little story I have too.

I worked several summer for some great Ophthalmologists in my home town (Toronto). One of them is married to a Radiologist. She (the OMD) told me that one day she saw a body float past her cottage (in Northern Ontario).... both her and her husband pulled the body out and .. well.... panicked. What's an OMD and a Radiologist going to do?? So they hastilly started CPR and called an ambulance. Well their neighbour, thank god, was an ER nurse .. when she showed up, both MD's were all too eager to let her take over.

You see, even though there were both MD's, an ER nurse would probably know more of what to do in that kind of a situation.

Let me just add that both of them do not register as Dr's when flying on any airlines. Can you imagine an OMD trying to do a tracheotomy? .... I wouldn't either, but just because you have MD behind you name doesn't necessarily imply that you are the be and and end all of health care.

My 0.02

 

[cushing]

Because my wife is a resident in ophthalmology I thought I'd offer this input to the discussion forum...

I think its ridiculous to compare an optometrist to an ophthalmologist...the optometrist is the primary eye care provider...the ophthalmologist is the surgeon...same area of medicine...different areas of expertise

Tom, I'd like to see what would happen if you told any surgeon to their face that they were your technician...lol

 

[UWSO2003]

Hey Cushing,

My girlfriend is in her third year of Med School and is looking at hopefully getting into Ophthalmology.

I think that you may have taken Tom too literally. As I'm sure you are well aware, even within Medincine, those who are surgeons are regarded differently than those who practice medicine. I have been told that the "medicine" people are of the opinion that surgeons are the "cutters" while they themselves are the thinkers.

I myself don't really care either way. This whole hierarchical arrogance belies the underlying fact that everyone is health care plays an important role in patient care. And to quote Tom ... I'm getting off my soapbox now too.

Having read many of Tom's posts, I have no doubt that he has a great deal of respect for Ophthalmologists. It would be naive for any OD to think that they don't need OMD's. Likewise, I hope that many OMD's feel that OD's play an important role in eye care.

So because Tom calls feels that OMD's are "surgical technicians", you don't need to take offense. As I see it, he still refers to them and requires their expertise to manage his patients.

Don't we all just want to go out to McDonald's now and buy eachother lunch!

 

[TomOD]

I guess I should clarify my comment's a little. I have great respect for most doctors, including, but not limited to, ophthalmologists. Whereever you go, you will find good one's (doctors that is) and bad ones. I find that it really doesn't matter what school they went to.

Your statement about the two profession as being distinct (one is medical and one is surgical or something like that) is not true. In fact, the scope of practice between OD's and OMD's blur about 85% of the time. It has been estimated that 80% of all ophthalmic surgery is performed by about 20% of Ophthalmologist. The remaining 80% or so are in direct competition with optometry. Hence, the conflict. The older OMD's here that I mentioned earlier don't even do surgery any longer. They are essentially optometrist.

I have had to quit referring patients to one OMD/OD referral group because they had a bad habit of keeping MY patients. I would send them in for cataract surgery. They would do the surgery and try to get them to come back every 3-4 months for dilated fundus exam and visual fields. Hello......they are MY patient that I have seen over the years. I can do (a very good and through) dilated fundus exam, with a 20D and 90D fundus lens (with photos) and visual fields.

I had to FIRE them. They were thieves and dishonest. I now work very well with another referral group of outstanding ophthalmologist. In fact, I am having lunch with them tomorrow and Wednesday. One is a great retinal surgeon and an all-around stud. The other is a glaucoma specialist and the third specializes solely on the cornea and anterior segment. They are happy to concetrate on doing surgery and get ALOT of referrals (and making much more money I am sure, than I am). I have no problem with that. They are outstanding at what they do.

Unlike organized ophthalmology, whos primary goal is to put down anything optometry, OD's are simply trying to do what that KNOW they can do.

 

[puffy1]

Wow, this thread really picked up since my last post.

If OMD's really wanted to "squash" optometry, they could. Like I said before, it's all about trying to protect one's territory.

 

[ussdfiant]

I am a soon to be DO student who has been lurking in this forum. I assume that an OMD is an opthalmologist, but what do the letters "O", "M", "D" stand for?

 

[TomOD]

OMD is just an abbreviation some use for Ophthalmologist. It is not really a highly used abbreviation.....just shorter and easier to type.

A few years back the American Academy of Ophthalmology tried to get all of it's members to use the term "EyeMD" to distinguish themselves from optometrists. Most thought it was stupid and didn't use it. After all there are not "HeartMD's" or "BoneMD's". They figured the public could better identify them.

 

[JPFL75]

IMHO the field of optometry is slowly but surely expanding beyond the scope of its practice. Certain states allow ODs to perform minor laser eye surgery. There are even some ODs who think they should be allowed to perform LASIK. I have no problems with utilizing the services of an OD in the future. They are very well trained at what they do. In addition, I wouldn't want to waste my time doing what they do on a regular basis anyways. I definitely respect ODs. However, that level of respect quickly deteriorates and turns to disgust when I see what certain optometric "physicians" are trying to do.

 

[UWSO2003]

Ok,

Not that this topic deserves any further attention, but I just can't help myself.

Can you (ie. poster above) explain why you feel that OD's are expanding outside the scope of practice?

Have you bothered to educate yourself regarding the level of training that we receive .. or are you stating your opinion as fact?

My girlfriend is currently in medical school and we discuss this topic all the time. What is frightening is how so many people blindly (no pun intended) trust their GP's for eyecare ... some GP's even go as far as refracting.

As technology and level of training of OD grads advances, should we not consider the fact that there should be a natural evolution of the scope of practice?

I just hope that you keep an open mind without prejudice.

Merry Christmas and happy holidays all.

 

[JPFL75]

Freddie,

I am not comparing an optometric physician to a general internist. I am making a comparison between an optometrist and an ophthalmologist.

I am fully aware of the rigorous and in depth study that it takes to become an optometrist. I'm a third year in a medical school that also has an optometry school.

I believe that optometrists provide excellent primary eye care to their patients. Therefore, I believe that the surgical aspects of the eye and its related structures is best handled by an ophthalmologist, a surgeon, who has completed a 4 year surgical residency in ophthalmology following 4 years of medical school.

Many ophthalmologist choose to refine their surgical area of expertise with further training in 1-3 year fellowships in retina-vitreous surgery, occuloplastic surgery, glaucoma, cornea and external diseases, and neuro-ophthalmology.

Also, I have no idea where TomOD got his statistic from. Every single OMD that I know of performs surgery as part of their practice. Like I said before...an ophthalmologist is an eye surgeon. Why wouldn't they perfrom surgery unless they were very old and close to retirement or unable to because of a physical disability.

 

[TomOD]

Hello All,

What I was referring to on the earlier post was that while virtually all OMD's perform surgery there are a relative few "cataract cowboys and Refractive docs" that do quite a few more procedures then average. These are usually the ones advertising on T.V. and radio or working at the large referral centers. Most "regular" OMD's now combine surgical and medical eyecare with refractive care and eyewear which has been traditionally OD's field. So I guess the question is which came first....OD's expanding their scope of practice (to treating eye diseases) or OMD's expanding theirs (into refracting and dispensing).

But not to worry, there are plenty of eyes for all and if you are a good doctor (no matter what degree), then the patients will come....mostly from good word-of-mouth.

MERRY CHRISTMAS TO ALL....

Tom, OD

 

[Purifyer]

Originally posted by Jubileee:
•Basically the arguement that Dr. Bates puts up is that the majority of refraction errors and even organic problems like iritis and glaucoma are disorders due to a strained state. That all that is required to get rid of this is learning how to relax the muscles in the eye.
•••

Heh, just thought I'd add something. I wear glasses that... make me able to see stuff in the distance . Anyway, I was hypnotised (for nothing related to my eyes). After the session, I had virtually perfect vision without my glasses! It was amazing... unfortunately after a few hours my eyes were f*cked again Oh well . So, this theory of muscle relaxation sounds reasonable to me