Ophtho working in an optical shop

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DOCTORSAIB

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Ophtho resident here looking to make some side money on the weekends during residency. I have a few job prospects lined up with some ODs who work out of chain optical shops. Basically I'll be functioning like an OD -- eye exams, CLs etc.

What's the usual hourly rate I should expect in these types of set ups? $50/hr?

Oh and I'm located NE region.
 
Ophtho resident here looking to make some side money on the weekends during residency. I have a few job prospects lined up with some ODs who work out of chain optical shops. Basically I'll be functioning like an OD -- eye exams, CLs etc.

What's the usual hourly rate I should expect in these types of set ups? $50/hr?

Oh and I'm located NE region.

I don't think a tech makes that much. You could however expect to make more money after you get your license.
 
I don't think a tech makes that much. You could however expect to make more money after you get your license.

Medical residents already have licences. Also, as any ophtho resident has completed his/her internship, so he/she probably already has a full license.
 
Ophtho resident here looking to make some side money on the weekends during residency. I have a few job prospects lined up with some ODs who work out of chain optical shops. Basically I'll be functioning like an OD -- eye exams, CLs etc.

What's the usual hourly rate I should expect in these types of set ups? $50/hr?

Oh and I'm located NE region.

That sounds about right.
 
Medical residents already have licences. Also, as any ophtho resident has completed his/her internship, so he/she probably already has a full license.

In what field do they have a license?

I am assuming the OP just graduated from medical school I.E MD degree, so even if he/she is starting there 1st year in the optho residency, how can he/she have knowledge that could only be attained by going to optometry school or actually completing his/her residency?
 
In what field do they have a license?

I am assuming the OP just graduated from medical school I.E MD degree, so even if he/she is starting there 1st year in the optho residency, how can he/she have knowledge that could only be attained by going to optometry school or actually completing his/her residency?

I graduated from a DO school in 2008.

In medicine we get unrestricted license to practice medicine. It's not specific to any field, hence "unrestricted." And it's given by the state. Most states have requirements that you graduate medical school, pass all 3 steps of your medical board exam (USMLE/COMLEX) and complete a 1 year internship (which I have). Only then can one apply for said license.

I'm a PGY-3 (2nd year ophtho) and feel comfortable seeing patients on my own in an optical shop set up.
 
In what field do they have a license?

I am assuming the OP just graduated from medical school I.E MD degree, so even if he/she is starting there 1st year in the optho residency, how can he/she have knowledge that could only be attained by going to optometry school or actually completing his/her residency?

I graduated from a DO school in 2008.

In medicine we get unrestricted license to practice medicine. It's not specific to any field, hence "unrestricted." And it's given by the state. Most states have requirements that you graduate medical school, pass all 3 steps of your medical board exam (USMLE/COMLEX) and complete a 1 year internship (which I have). Only then can one apply for said license.

I'm a PGY-3 (2nd year ophtho) and feel comfortable seeing patients on my own in an optical shop set up.

Yep.
 
I graduated from a DO school in 2008.

In medicine we get unrestricted license to practice medicine. It's not specific to any field, hence "unrestricted." And it's given by the state. Most states have requirements that you graduate medical school, pass all 3 steps of your medical board exam (USMLE/COMLEX) and complete a 1 year internship (which I have). Only then can one apply for said license.

I'm a PGY-3 (2nd year ophtho) and feel comfortable seeing patients on my own in an optical shop set up.

What do you learn during the internship year? What is the purpose of the internship year? What is the difference between residency and internship?

By a unrestricted license in medicine, do you mean to say that can you practice in any field you choose to? I.E. practice as a GP, radiology or must you complete a RESIDENCY for specialty areas like radiology?

Also, optometry is not part of medicine, so how would a do/md be able to practice optometry without having gone to optometry school or completed a omd RESIDENCY rather than an INTERNSHIP, just wondering.

Sorry for all these questions, but I do not understand how a MD/DO without an OMD residency can practice full-scope optometry. I mean, how do you learn diagnoses for diseases + various procedures in a span of what 1/2 years WITHOUT having the required knowledge of the ocular system, which I suppose is taught in Y1-Y2 of optometry school.

thanks. 😳
 
Sorry for all these questions, but I do not understand how a MD/DO without an OMD residency can practice full-scope optometry. I mean, how do you learn diagnoses for diseases + various procedures in a span of what 1/2 years WITHOUT having the required knowledge of the ocular system, which I suppose is taught in Y1-Y2 of optometry school.

thanks. 😳

He doesn't have to knowledge to practice optometry OR ophthalmology. He expects to go in and basically do refractive type "exams". He probably doesn't realize that he is exposing himself to considerable liability. Just because some half-assed mall craptical OD is getting away with doing a refraction and an "air puff" doesn't make it the right thing to do. The mall is for people trying to cirumvent proper eye examination.
 
In what field do they have a license?

I am assuming the OP just graduated from medical school I.E MD degree, so even if he/she is starting there 1st year in the optho residency, how can he/she have knowledge that could only be attained by going to optometry school or actually completing his/her residency?

A medical license allows you to practice any aspect of medicine and not limited by specialty. You won't see an ophthalmologist practicing radiology or vice versa because of reimbursement and liability issues. The medical license of an ophthalmologist and radiologist, however, is the same.

So, is a refraction and basic eye exam the practice of optometry or the practice of medicine? It can be both because of the overlap of the two fields.

Is it ethical for the poster to moonlight in an optometrist office? The poster is a not a new graduate. He's had one year of ophthalmology training. In a low pathology retail location, the exams should not be over his head.

Will he know enough to refract? That question can be answered by the number of Rx checks and remakes comes back to the office.
 
He doesn't have to knowledge to practice optometry OR ophthalmology. He expects to go in and basically do refractive type "exams". He probably doesn't realize that he is exposing himself to considerable liability. Just because some half-assed mall craptical OD is getting away with doing a refraction and an "air puff" doesn't make it the right thing to do. The mall is for people trying to cirumvent proper eye examination.

What is the difference between a "refractive type exam" and real eye exam?
 
What is the difference between a "refractive type exam" and real eye exam?

The "refractive" exam has a predetermined outcome, as refraction is the sole purpose of the exam, with all else taking a backseat. These are really common, and the public has come to expect this. The fact that they have diabetes or any of a thousand other symptoms, signs, or relevent history is secondary to the desperate need to check their refraction. The retail opticals happily oblige them this, as this is conducive to their business model. If you work there, you will be expected to "fit the mold", and they will coerce you.

A real eye exam is determined based on the case presentation and is entirely different.
 
The "refractive" exam has a predetermined outcome, as refraction is the sole purpose of the exam, with all else taking a backseat. These are really common, and the public has come to expect this. The fact that they have diabetes or any of a thousand other symptoms, signs, or relevent history is secondary to the desperate need to check their refraction. The retail opticals happily oblige them this, as this is conducive to their business model. If you work there, you will be expected to "fit the mold", and they will coerce you.

A real eye exam is determined based on the case presentation and is entirely different.

I think that is an over-generalization and probably insulting to your colleagues who practice in the retail setting. I hope optometrists in any setting have more integrity than that. If a diabetic refuses a dilated exam, that's his choice. As a practitioner, your obligation is to offer it.
 
What do you learn during the internship year? What is the purpose of the internship year? What is the difference between residency and internship?

By a unrestricted license in medicine, do you mean to say that can you practice in any field you choose to? I.E. practice as a GP, radiology or must you complete a RESIDENCY for specialty areas like radiology?

Also, optometry is not part of medicine, so how would a do/md be able to practice optometry without having gone to optometry school or completed a omd RESIDENCY rather than an INTERNSHIP, just wondering.

Sorry for all these questions, but I do not understand how a MD/DO without an OMD residency can practice full-scope optometry. I mean, how do you learn diagnoses for diseases + various procedures in a span of what 1/2 years WITHOUT having the required knowledge of the ocular system, which I suppose is taught in Y1-Y2 of optometry school.

thanks. 😳

During intern year you do everything but the eye. This year can be spent on the internal medicine service or general surgery service. Usually it's a very busy year where you learn how to be a better clinician.

During residency you learn ophthalmology where you do nothing but the eye (i.e. no more chest pain, strokes, GI bleeds, COPD exacerbation, ICU, etc).

An unrestricted license allows you to practice BY LAW. However, if all you do is an internship year and get your unrestricted license you will only really be able to practice basic primary care medicine -- this used to be called a "GP." The other problem will be you will have a heck of a time trying to get malpractice insurance or be allowed to admit patients to a hospital. Hence why it's so important these days to do a full residency and become board-certified.

In the first 2 years of medical school we only learn the basics of the eye (anatomy, histology, physiology, etc). You're right, after that we don't learn jack until we get to ophtho residency. So someone with just a MD/DO and an intern year under their belt is by no means ready to see eye patients.

However, during residency we have a steep learning curve. We see A TON of pathology, attend lectures and have to study for our annual in-service exam (OKAPs). All that plus seeing emergencies in the ER and doing consults in the hospital. So by the end of your 1st year of ophtho residency (depending on your program and the work ethic of the individual) one should be able to do basic eye exams, general CL fittings and refractions.

He doesn't have to knowledge to practice optometry OR ophthalmology. He expects to go in and basically do refractive type "exams". He probably doesn't realize that he is exposing himself to considerable liability. Just because some half-assed mall craptical OD is getting away with doing a refraction and an "air puff" doesn't make it the right thing to do. The mall is for people trying to cirumvent proper eye examination.

I'm actually quite OCD with my exams even if they're there for just glasses.

Pardon my ignorance but what is this considerable liability you speak of? I was under the impression that optometry/ophthalmology are low risk specialities esp if you're non-surgical.
 
I think that is an over-generalization and probably insulting to your colleagues who practice in the retail setting. I hope optometrists in any setting have more integrity than that. If a diabetic refuses a dilated exam, that's his choice. As a practitioner, your obligation is to offer it.

do you think its ok to provide "refractive exams" to pts with diabetes? my feeling is that it isn't ok.

my experience says its FAR from "over-generalization", in fact its more the rule then the exception. Granted its my mere anecdote but I have worked in varied retail environments. I believe there is considerable "job security" pressure exerted on those who practice in a retail setting.
 
I'm actually quite OCD with my exams even if they're there for just glasses.

Pardon my ignorance but what is this considerable liability you speak of? I was under the impression that optometry/ophthalmology are low risk specialities esp if you're non-surgical.

I'm sure you are, so that isn't the limiting factor. Working in the mall, you WILL see people with frank and obvious disease (or at least are at obvious risk) who just want a refraction. The people are the limiting factor, and the corporate boss will want the eyeglass sale......soooooooo, you do the math. You will have to choose what to do.

I think the liability is obvious isn't it? example, if you perform an undilated exam on a 70yo with dense cataract, who has multiple co-morbid conditions affecting the eye, sign off on the refraction/chart and then you are on the hook.
 
do you think its ok to provide "refractive exams" to pts with diabetes? my feeling is that it isn't ok.

It's not OK to do a refractive exam by your definition. However, if a patient doesn't want want a dilation, that's their choice. As long as you explain to them the importance of it. If a patient has raging PDR, but refuses to be referred, it's his choice. As long as you explained the risk of vision loss without treatment.

If a diabetic comes in for glasses, but no dilation is offered, then that is the doctor's fault. I think that is where the liability comes in.

So what do you do if a cash pay diabetic comes in for new glasses but refuses a dilation? Do you turn that patient away or refract them, do an undilated fundus exam, and have them sign a dilation refusal form?

Ultimately, you can't blame a crappy exam on being in a retail setting. Blame the crappy doctor without integrity. I've moonlighted in residency and was quite impressed with the standard of care in those settings.
 
I'm sure you are, so that isn't the limiting factor. Working in the mall, you WILL see people with frank and obvious disease (or at least are at obvious risk) who just want a refraction. The people are the limiting factor, and the corporate boss will want the eyeglass sale......soooooooo, you do the math. You will have to choose what to do.

I think the liability is obvious isn't it? example, if you perform an undilated exam on a 70yo with dense cataract, who has multiple co-morbid conditions affecting the eye, sign off on the refraction/chart and then you are on the hook.

I see what you're saying. Hopefully I can minimize such encounters. Thanks for your advice!
 
It's not OK to do a refractive exam by your definition. However, if a patient doesn't want want a dilation, that's their choice. As long as you explain to them the importance of it. If a patient has raging PDR, but refuses to be referred, it's his choice. As long as you explained the risk of vision loss without treatment.

If a diabetic comes in for glasses, but no dilation is offered, then that is the doctor's fault. I think that is where the liability comes in.

So what do you do if a cash pay diabetic comes in for new glasses but refuses a dilation? Do you turn that patient away or refract them, do an undilated fundus exam, and have them sign a dilation refusal form?

Ultimately, you can't blame a crappy exam on being in a retail setting. Blame the crappy doctor without integrity. I've moonlighted in residency and was quite impressed with the standard of care in those settings.

currently I turn them away, and I'm not proud of it, but I think these people need to get a real exam and I see little point in providing a refractive exam
(other then trying to make money). I also don't want to expose myself to that liability. I'm not holier then thou but exactly what is the point of measuring their eyeglasses when they have a potentially blinding condition? I suppose if there was no liability then I could feel comfortable just measuring their eyeglasses and doing an undilated exam but again is that the best thing? I realize I'm probably the minority opinion on this but I just don't "get it". what is the logic? some exam is better then no exam? I've heard that before but I'm not comfortable with that. Informed refusal is dicey from what I've read and though I haven't seen any involving opthalmic cases, I'm sure that they are out there.
 
currently I turn them away, and I'm not proud of it, but I think these people need to get a real exam and I see little point in providing a refractive exam
(other then trying to make money). I also don't want to expose myself to that liability. I'm not holier then thou but exactly what is the point of measuring their eyeglasses when they have a potentially blinding condition? I suppose if there was no liability then I could feel comfortable just measuring their eyeglasses and doing an undilated exam but again is that the best thing? I realize I'm probably the minority opinion on this but I just don't "get it". what is the logic? some exam is better then no exam? I've heard that before but I'm not comfortable with that. Informed refusal is dicey from what I've read and though I haven't seen any involving opthalmic cases, I'm sure that they are out there.

I agree with you PBEA. I'm not in practice yet, so won't know what my policy will be. It's a tricky issue no doubt.

My limits have been to refuse to prescribe or give trials of contact lenses to patients who are obviously abusing them (multiple corneal scars from prior infections 😱). I make them get a pair of glasses before doing the contact lens exam. In some cases, I won't prescribe the contact lenses under any circumstances.

In well controlled diabetics who refuse a dilated exam, that's their business. In a diabetic on hemodialysis who hasn't had a dilated exam in years, I wouldn't feel comfortable so would turn them away.

There are so many other examples. What do you do with a noncompliant glaucoma patient? What about a patient with a corneal ulcer but continues to wear contact lenses despite warnings? A patient with papilledema?

Sometimes you won't know that you're in one of these tricky situations until you've done the exam. At that time you're already on the hook. I do the best exam I can and make my recommendations.
 
I started out in a teaching hospital and taught some of the refractive stuff & some clinical procedures to the ophthalmology residents.

I do think by their 2nd year they'd be able to do this & I had a couple residents that looked into moonlighting.
If you decide to do it:
  • Check with your malpractice carrier-the hospital's policy won't cover this.
  • Don't sign up as a panel provider for any medical or vision insurance. All cash will be easier for you and may run into snags getting credentialled when your education in incomplete.
  • Turf complex cases, including CL fits & strange refractions.
  • Realize that in a worst-case scenario, you'll be held out to dry in court. A lawyer will have a field day with the fact that you're practicing unsupervised before completing your training. You'll be held to the same standard as a board certified OMD, so don't let a CL-abusing 15 y.o. that ends up with permanent vision loss due to an ulcer ruin your career before you start it!
 
During intern year you do everything but the eye. This year can be spent on the internal medicine service or general surgery service. Usually it's a very busy year where you learn how to be a better clinician.

During residency you learn ophthalmology where you do nothing but the eye (i.e. no more chest pain, strokes, GI bleeds, COPD exacerbation, ICU, etc).

An unrestricted license allows you to practice BY LAW. However, if all you do is an internship year and get your unrestricted license you will only really be able to practice basic primary care medicine -- this used to be called a "GP." The other problem will be you will have a heck of a time trying to get malpractice insurance or be allowed to admit patients to a hospital. Hence why it's so important these days to do a full residency and become board-certified.

In the first 2 years of medical school we only learn the basics of the eye (anatomy, histology, physiology, etc). You're right, after that we don't learn jack until we get to ophtho residency. So someone with just a MD/DO and an intern year under their belt is by no means ready to see eye patients.

However, during residency we have a steep learning curve. We see A TON of pathology, attend lectures and have to study for our annual in-service exam (OKAPs). All that plus seeing emergencies in the ER and doing consults in the hospital. So by the end of your 1st year of ophtho residency (depending on your program and the work ethic of the individual) one should be able to do basic eye exams, general CL fittings and refractions.



I'm actually quite OCD with my exams even if they're there for just glasses.

Pardon my ignorance but what is this considerable liability you speak of? I was under the impression that optometry/ophthalmology are low risk specialities esp if you're non-surgical.

Thanks for the detailed response. Although, I now I think optometry school is redundant.
 
If the OMD resident/intern, has learned enough to perform refractions, and because they are licensed, they can work on per diem basis.

Would the same apply to OD's, who are lets say in there 2-3rd year? The difference between the OD/OMD is that a) the od has more knowledge of eye care in general b) the od does not have a licence, whereas the MD does.

I understand interns have a license which allows them to refract, but if ODs are not allowed to moonlight, like OMDS, because they do not have a license, yet have more or as much knowledge as interns about the EYE, then there is a problem.
 
If the OMD resident/intern, has learned enough to perform refractions, and because they are licensed, they can work on per diem basis.

Would the same apply to OD's, who are lets say in there 2-3rd year? The difference between the OD/OMD is that a) the od has more knowledge of eye care in general b) the od does not have a licence, whereas the MD does.

I understand interns have a license which allows them to refract, but if ODs are not allowed to moonlight, like OMDS, because they do not have a license, yet have more or as much knowledge as interns about the EYE, then there is a problem.

Socal2014.... I think you are confused about the hierarchy of medicine. We're not taking about medical interns without any eye training doing eye exams. Resident and intern are often used interchangeably, but they are slightly different.

"OD's, who are lets say in there 2-3rd year". I assume you are talking about optometry students. Then in this situation, you can't call them an OD because they don't yet have a degree or their license, therefore can't practice. Just like medical students can't moonlight in an urgent care or something similar.
 
Socal2014.... I think you are confused about the hierarchy of medicine. We're not taking about medical interns without any eye training doing eye exams. Resident and intern are often used interchangeably, but they are slightly different.

"OD's, who are lets say in there 2-3rd year". I assume you are talking about optometry students. Then in this situation, you can't call them an OD because they don't yet have a degree or their license, therefore can't practice. Just like medical students can't moonlight in an urgent care or something similar.

Licensure is a silly excuse to be honest. I don't see why medicine has to bombard other professions, like optometry, which is in now way related to MEDICINE. If it were, there would be no such thing as an optometry school.

Just sayin' 😳
 
Licensure is a silly excuse to be honest. I don't see why medicine has to bombard other professions, like optometry, which is in now way related to MEDICINE. If it were, there would be no such thing as an optometry school.

Just sayin' 😳

I don't get that statement. To me, that seems like saying "licensure is just a silly excuse to not be able to drive a car." I mean, as long as you're good at the local go-kart track, you should be able to drive a car. Huh?

Maybe you could clarify that.
 
I don't get that statement. To me, that seems like saying "licensure is just a silly excuse to not be able to drive a car." I mean, as long as you're good at the local go-kart track, you should be able to drive a car. Huh?

Maybe you could clarify that.

If an optho is able to practice optometry after obtaining a MD degree and a 1 yr internship, then so should the 2nd-3rd year student who has as much knowledge as the MD. I mean, if you could prove that you have learned the required information for optometric care, in a 5 year span, along with learning everything about the human body, then by all means, you should practice optometry. If not, then I suppose you could simply do refractions, BUT, so should the optometry student.

(No offense OP, just stating what I think is fair)
 
If an optho is able to practice optometry after obtaining a MD degree and a 1 yr internship, then so should the 2nd-3rd year student who has as much knowledge as the MD. I mean, if you could prove that you have learned the required information for optometric care, in a 5 year span, along with learning everything about the human body, then by all means, you should practice optometry. If not, then I suppose you could simply do refractions, BUT, so should the optometry student.

(No offense OP, just stating what I think is fair)

With just an internship under your belt, no one is going to let you practice on eyes. The OP in this case also has about 15 months of hideously intense ophtho training under his/her belt (so 6 years and a little more of total training to this point). You will also note that no medical students have any kind of independence either, its not like MD/DO students have all this autonomy that OD students don't.

Knowing what little I do from my home institution, the first year of ophtho residency was structured to be, basically, learning how to do all of the things that ODs do in terms of eye care. Obviously there are more office procedures and less time with refraction/CL fittings, but the basic principles are the same. I'm not suggesting that all of optometry school can be fit into 1 year of residency, but after 1 year an MD/DO should be competent enough to handle well vision exams and have enough of a handle on pathology to either handle it themselves or have a good idea what's going on when they refer out.
 
If an optho is able to practice optometry after obtaining a MD degree and a 1 yr internship, then so should the 2nd-3rd year student who has as much knowledge as the MD. I mean, if you could prove that you have learned the required information for optometric care, in a 5 year span, along with learning everything about the human body, then by all means, you should practice optometry. If not, then I suppose you could simply do refractions, BUT, so should the optometry student.

(No offense OP, just stating what I think is fair)

So your suggestion then is to allow students to take the licensing exam whenever they want to during the course of the optometric program and if they pass, they can drop out and just start seeing patients? 😕
 
OP, you should check state laws. In certain states, it is illegal for a lay corporation to hire an MD...while it may be perfectly legal to hire an OD. And in some states, it is illegal to hire either an MD or OD, and you would have to lease the space...thereby having no assured salary.
 
OP, you should check state laws. In certain states, it is illegal for a lay corporation to hire an MD...while it may be perfectly legal to hire an OD. And in some states, it is illegal to hire either an MD or OD, and you would have to lease the space...thereby having no assured salary.

An excellent point. I've learned so much from this thread.

So I did a google search and came up with this:

http://www.dobbinslaw.com/cpmarticle.html

Should I be looking elsewhere as well?
 
An excellent point. I've learned so much from this thread.

So I did a google search and came up with this:

http://www.dobbinslaw.com/cpmarticle.html

Should I be looking elsewhere as well?

That issue likely won't come up because you're going to be considered an independent contractor anyways. I would say your biggest issue is making sure that your malpractice insurance through the hospital covers you while moonlighting. If it does not, you will need to get your own which might be interesting because you're not an optometrist and if you ask for a policy for an ophthalmologist, you might pay through the nose even if you don't do any surgery.
 
That issue likely won't come up because you're going to be considered an independent contractor anyways. I would say your biggest issue is making sure that your malpractice insurance through the hospital covers you while moonlighting. If it does not, you will need to get your own which might be interesting because you're not an optometrist and if you ask for a policy for an ophthalmologist, you might pay through the nose even if you don't do any surgery.

Doc, good point. I will be an IC and will pay my own taxes.

In terms of malpractice, I talked to an OMIC rep recently. It seems like everyone gets a 75% discount their 1st year in practice, then 50% your 2nd year, then 25%, etc. So by 4 years out in practice you end up paying 100% of the bill. If I get malpractice now (even as part-time status, nonsurgical) I will start to eat away at my tapering discount, not to mention paying for tail coverage as well at the end.

I'm a bit apprehensive about this as I don't want this to work against me in a few years when I decide to join a practice and they freak out when they realize they'll be paying 100% on my malpractice on day 1 b/c I already used up the tapering discount as a resident doing IC work.

I talked to one of my attendings who used to do side work in an optical shop as a resident a few years back. He said he got his malpractice through an Optom company since he was essentially "working as an Optom." If I can do that, maybe I can save my tapering discount with OMIC for when I'm done with my training.

Thoughts?
 
I talked to one of my attendings who used to do side work in an optical shop as a resident a few years back. He said he got his malpractice through an Optom company since he was essentially "working as an Optom." If I can do that, maybe I can save my tapering discount with OMIC for when I'm done with my training.

Thoughts?

If that's feasible, that's probably your best bet. It won't cost you more than a couple of hundred bucks for the year.
 
What is the difference between a "refractive type exam" and real eye exam?

Ophthalmologists and optometrists will often divide the exam into the refractive component and the "medical" component. I don't necessarily agree with doing this but it is perfectly legal. The refractive component is essentially just measuring for glasses. The medical component includes the dilation and thorough examination of the eye for signs of pathology. I do it all in one exam, but as I understand it you can do it on 2 separate visits and bill for 2 exams, so some people do it that way as a way to increase revenue.

There is nothing particularly "wrong" with performing just a refractive exam on a diabetic, so long as you explain to them the importance of getting the medical part done at some point (at some point each year, not some point this decade). The problem is can you actually get them to understand that. There are some dumb people out there, and some people that are just plain ignorant. I suppose turning them away completely from a retail setting may be a wake up call that they need to have a medical exam, but I suspect a lot of them will just go down the street to the next retail location who will happily serve them.

If an optho is able to practice optometry after obtaining a MD degree and a 1 yr internship, then so should the 2nd-3rd year student who has as much knowledge as the MD. I mean, if you could prove that you have learned the required information for optometric care, in a 5 year span, along with learning everything about the human body, then by all means, you should practice optometry. If not, then I suppose you could simply do refractions, BUT, so should the optometry student.

(No offense OP, just stating what I think is fair)

First off, life isn't fair 😉 However I think the main issue is that an ophtho resident already has a degree (MD) and a license as some people have pointed out. You could debate back and forth over who has more knowledge between a 2nd year ophtho resident and 3rd/4th year optometry students. I suspect it varies from case to case.
 
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