Optometrist-Ophthalmologist Relations

[VA Hopeful Dr]

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In another thread, there's been some interest shown in discussing the business relationship between MDs and ODs. I figured a new thread was in order, just to keep things organized.

Let's please keep this civil and not have another MD vs OD debate, we've had plenty of those already.

I'll start out with a few thoughts I've had and we'll see where it goes from there.

Simple Fact - There are too many patients with medical eye problems for the MDs to see them all. Therefore, ODs must have some role in the medical scheme of things. Discuss

Ideal - What would be the ideal relationship between an MD and an OD regarding patient care, referrals, co-management?

Referrals - There are some things that ODs just have to refer out - surgery being the main, but also some complex issues depending on the comfort level of the OD or their scope of practice. But here's an idea the ODs in my hometown have been playing with, should make for good discussion. MDs are the surgeons (not ONLY surgeons, but they are the only surgeons), so of course they get all surgical cases. But, I think most people will agree that ODs tend to have more knowledge and experience with contacts (OD curriculums stress this pretty highly). In the interest of both fairness and deference to highest care, should ODs be allowed to handle the majority of CL patients?

Thoughts?

 

[Ben Chudner]

Simple Fact - There are too many patients with medical eye problems for the MDs to see them all. Therefore, ODs must have some role in the medical scheme of things. Discuss

I do not believe this is an accurate statement. I don't think there is any data to support this "simple fact".

Ideal - What would be the ideal relationship between an MD and an OD regarding patient care, referrals, co-management?

I think the ideal situation is different depending on whether you ask an OD or an MD. I'll give you my opinion, but be aware this is only an opinion of one OD. In MY ideal situation, there would be no general ophthalmologists. OD's would be responsible for all general eyecare. For those patients that require diagnostic testing or treatment that is beyond the scope of optometry, OD's would refer to the appropriate sub-specialist. Corneal specialists would handle our cataract surgery which is really all that most of us refer to general ophthalmologists anyway, unless there is no sub-specialist in the area. This allows the surgeons to be surgeons and also ensures that their clinics are filled with the more advanced and interesting cases. It also leaves the routine cases and the less advanced, less interesting (to MD's, but maybe interesting to OD's) cases to us.

Referrals - There are some things that ODs just have to refer out - surgery being the main, but also some complex issues depending on the comfort level of the OD or their scope of practice. But here's an idea the ODs in my hometown have been playing with, should make for good discussion. MDs are the surgeons (not ONLY surgeons, but they are the only surgeons), so of course they get all surgical cases. But, I think most people will agree that ODs tend to have more knowledge and experience with contacts (OD curriculums stress this pretty highly). In the interest of both fairness and deference to highest care, should ODs be allowed to handle the majority of CL patients?

I agree that surgery should be left to the surgeons, and refractive treatments like contact lenses and glasses should be left to the OD's. The problem is all the stuff in the middle where MD's feel the OD's are encroaching upon their territory. I don't know that we will ever find a middle ground where both sides will agree.

 

[gsinccom]

....I cut and pasted the last response in the other thread just to make sure that this discussion is focused to this new thread and not the other one where it began..thanks - i.e., this is Ben's response to Richard Hom's comments regarding my urging that we now tackle the OD/OMD relationship question.

Ben Chudner
Registered User
100+ Posts


Join Date: Apr 2005

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Quote:
Originally Posted by Richard_Hom
Dear gsinccom,

The best relationship unfortunately is far apart in the views of each profession. The most outspoken on each side are fervent in their opinions. Here is my views, though.

1. Ophthalmology-optometry joint practice where each can share in the proceeds of their efforts. In addition, there is equity of some kind that is possible.

2. Optometrists are the first to see the patient to determine whether refractive, medical or surgical care is appropriate (or all), especially if referred by primary care medicine. Where necessary, the optometrist may definitively medically manage the patient. When appropriate, the optometrist will refer to the ophthalmologist for specialty care and return the patient to the optometrist for continuing surveillance (an example would be a diabetic who may have moderate or advance NPDR without retinal edema or thickening who is not yet ready for medical or laser surgical intervention).

3. The ophthalmologist concentrates on complex medical and surgical care. They shouldn't be seeing any well-seeing patients at all. Except for ego-hungry patients who are well-seeing, which you can never dissuade.

The above is a foundation. Anybody else want to chime in? Of course, let's not get into who is better arguement.

Richard_Hom

Well said

 

[VA Hopeful Dr]

I do not believe this is an accurate statement. I don't think there is any data to support this "simple fact".

I would think it is. Granted, I can't speak for all of the country, but everywhere that I've lived (throughout the south), MDs tend to have a very long wait for new patients (2 months is not unheard of). Given that they are this busy with ODs already seeing many of the medical problems, that would suggest to me that if the MDs were to take all the medical problems, they would be swamped .

 

[Ben Chudner]

I would think it is. Granted, I can't speak for all of the country, but everywhere that I've lived (throughout the south), MDs tend to have a very long wait for new patients (2 months is not unheard of). Given that they are this busy with ODs already seeing many of the medical problems, that would suggest to me that if the MDs were to take all the medical problems, they would be swamped .

Here are several possibilities why an ophthalmologist would be booked out so much.

1) Most MD's have at least one, if not two surgery days. This means they are not in clinic seeing patients during that time. That could translate into as much as 40% less clinic time.

2) For every cataract surgery, there is at least one post-op visit. There are more if the MD is not co-managing with another doctor. If the average MD performs 12 cases a week, that adds anywhere from 12 to 36 patient encounters per week (assuming the most a patient would be seen is 3 times in the first month after surgery). If the doctor only has four clinic days per week that means an extra 3 to 9 patients per day. Granted, these patients do not take up much time, but they do take an appointment slot.

3) 70% of all patients seen in an ophthalmology clinic is seen more than once per year. This includes all of the post-ops, but as you can see, this can take away available appointment slots, especially when the doctor does not see clinic patients every day.

4) In a lot of states, OD's cannot get on medical panels. Therefore, many patients with a simple medical diagnosis such as cataracts or even pseudophakia, can be seen by MD's as a medical visit as opposed to having to pay out of pocket at an OD office.

My point is that there are several reasons why an MD is busier than an OD, and none of them have to do with medical eye problems. There is no scientific eveidence to suggest that there is too many medical eye problems for the MD's to see them all which was the "fact" I was disagreeing with.

 

[VA Hopeful Dr]

Here are several possibilities why an ophthalmologist would be booked out so much.

1) Most MD's have at least one, if not two surgery days. This means they are not in clinic seeing patients during that time. That could translate into as much as 40% less clinic time.

2) For every cataract surgery, there is at least one post-op visit. There are more if the MD is not co-managing with another doctor. If the average MD performs 12 cases a week, that adds anywhere from 12 to 36 patient encounters per week (assuming the most a patient would be seen is 3 times in the first month after surgery). If the doctor only has four clinic days per week that means an extra 3 to 9 patients per day. Granted, these patients do not take up much time, but they do take an appointment slot.

3) 70% of all patients seen in an ophthalmology clinic is seen more than once per year. This includes all of the post-ops, but as you can see, this can take away available appointment slots, especially when the doctor does not see clinic patients every day.

4) In a lot of states, OD's cannot get on medical panels. Therefore, many patients with a simple medical diagnosis such as cataracts or even pseudophakia, can be seen by MD's as a medical visit as opposed to having to pay out of pocket at an OD office.

My point is that there are several reasons why an MD is busier than an OD, and none of them have to do with medical eye problems. There is no scientific eveidence to suggest that there is too many medical eye problems for the MD's to see them all which was the "fact" I was disagreeing with.

Ok, I think I may have been unclear earlier. All of the surgery, post-op, pre-op, multiple visits were all things I had considered when I said "More eye problems than there were MDs to see them". I didn't just mean new problems every day. I should have, instead, said something that encompassed all of this. Perhaps "MDs have too much to do and not enough time to do it for them to see EVERY patient that needs ANY kind of medical treatment". If you include the surgery, pre-op, all post-op visits, and every medical eye problem in their area, then my statement holds true. I'm just not as coherent on paper as I am in my own head.

 

[Ben Chudner]

Ok, I think I may have been unclear earlier. All of the surgery, post-op, pre-op, multiple visits were all things I had considered when I said "More eye problems than there were MDs to see them". I didn't just mean new problems every day. I should have, instead, said something that encompassed all of this. Perhaps "MDs have too much to do and not enough time to do it for them to see EVERY patient that needs ANY kind of medical treatment". If you include the surgery, pre-op, all post-op visits, and every medical eye problem in their area, then my statement holds true. I'm just not as coherent on paper as I am in my own head.

ok