Optometrists for Diabetic Eye Exams

[corpsmanUP]

Hi guys,

I am a 4th year med student, PA-C x 6 years, and a husband of a type I diabetic. My wife routinely goes to the Eye Center for her dilated exam for screening for diabetic retinopathy. She has never actually been seen by the ophthalmologist and instead sees the optometrist who I have been told has extra training in this disease process. I thought that the ADA recommendation was to have a dilated exam by an ophthalmologist annually. My wife did not even realize that she was seeing the optometrist until this year when I noticed on the billboard the group recently bought that the lady seeing her all this time was an O.D. She was referred by her endo to this group and I sort of feel like she has been dooped! Anyone want to comment on this practice and whether or not it is appropriate? I am not in the loop enough to know if this is akin to my former job whereas a PA I routinely did things that people thought only a physician could do, but were well within my capability. I just don't know about this. Every year my wife's check is pefect and she has never had any proliferative changes, but now I am wondering if we should change practices for her. Let me hear from you ophtho's who know about this issue. Thanks in advance.

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[Tom_Stickel]

Hi guys,

I am a 4th year med student, PA-C x 6 years, and a husband of a type I diabetic. My wife routinely goes to the Eye Center for her dilated exam for screening for diabetic retinopathy. She has never actually been seen by the ophthalmologist and instead sees the optometrist who I have been told has extra training in this disease process. I thought that the ADA recommendation was to have a dilated exam by an ophthalmologist annually. My wife did not even realize that she was seeing the optometrist until this year when I noticed on the billboard the group recently bought that the lady seeing her all this time was an O.D. She was referred by her endo to this group and I sort of feel like she has been dooped! Anyone want to comment on this practice and whether or not it is appropriate? I am not in the loop enough to know if this is akin to my former job whereas a PA I routinely did things that people thought only a physician could do, but were well within my capability. I just don't know about this. Every year my wife's check is pefect and she has never had any proliferative changes, but now I am wondering if we should change practices for her. Let me hear from you ophtho's who know about this issue. Thanks in advance.

Corpsman_UP,

This is from the ADA website:

"See your eye care professional at least once a year for a dilated eye exam. ...Only optometrists and ophthalmologists can detect the signs of retinopathy. Only ophthalmologists can treat retinopathy."

Optometrists have the training to detect and diagnose diabetic retinopathy. We use the same slit lamps, lenses, and ophthalmoscopes as ophthalmologists. We all know the appropriate guidelines for when to refer for treatment for clinically significant macular edema and/or proliferative retinopathy. We can detect non-proliferative retinopathy just as early. And the ADA guidelines don't recommend one or the other

You'll notice that the statement also says that only ophthalmlogists treat retinopathy. What it doesn't say is that the overwhelming majority of the people treating retinopathy are retina specialists. In other words, unless you're routinely seeing a retina specialist, your ophthalmologist will refer you to one for your treatment, just as an OD would refer you to a retina specialist.

The real question is whether you trust the experience of the OD your wife is seeing. That's the same question you would have if you were seeing an ophthalmologist. Evidently your wife's endocrinologist has faith in the ability of the OD, otherwise he wouldn't have sent her there.

As an OD working in an ophthalmology office, I would say that it is somewhat akin to your PA position in that a lot of patients are surprised at what I can do. About once a week someone will say that I just gave them a better eye exam than their old OD and they're glad to see a "real" doctor. Then I just explain to them that I'm an OD too, and qualified to diagnose their problem and treat or refer as appropriate.

As far as feeling duped, I can only imagine that somewhere in the office, e.g. the front door, business cards, doctor bios, etc., it clearly states that your wife's doctor is an OD. Here at our 3 MD/1 OD office, we never go out of our way to make the distinction, and it's rarely an issue.

 

[corpsmanUP]

The issue to me is that my wife's referral always says "Dr X Ophtho", but she always see "Dr. Z Opto". In my wife's defense, the doctor's pictures in the waiting room simply has their name under them as "Dr. X", without the initials as to what kind of doctor they are. I only figured it out when I saw her picture myself and questioned it because she was way too young to be an ophtho...looked 25 max!!

So I certainly don't question the capability of an opto if they are truly qualified to do these exams, but I just don't like them passing her off as an ophtho!!

 

[dochopefull]

So I certainly don't question the capability of an opto if they are truly qualified to do these exams, but I just don't like them passing her off as an ophtho!!

Perhaps you are confusing her title with the dept. she is in. Ophthalmologists and Optometrists are all under the Ophthalmology field which you can furthur break down into specialties such as cornea, retina, neuro, etc. Optometry is just another sub-category under ophthalmology which encompasses everything. (Well at least thats how most hospitals I have worked at handle it, so I am assuming it is the same with yours.)

So when you see Dr. X Ophtho and not Opto...it is probably just denoting the field she is in.

Hope that helped!!

Be Well,

D

 

[brendang]

Perhaps you are confusing her title with the dept. she is in. Ophthalmologists and Optometrists are all under the Ophthalmology field which you can furthur break down into specialties such as cornea, retina, neuro, etc. Optometry is just another sub-category under ophthalmology which encompasses everything. (Well at least thats how most hospitals I have worked at handle it, so I am assuming it is the same with yours.)

So when you see Dr. X Ophtho and not Opto...it is probably just denoting the field she is in.

Hope that helped!!

Be Well,

D

i hate to rehash old sentiments, but you have to be joking... how many years is an optometry fellowship after an ophtho residency? i'm amazed optometrists who pawn themselves off as ophthalmologists aren't sued more often...

 

[Ben Chudner]

i hate to rehash old sentiments, but you have to be joking... how many years is an optometry fellowship after an ophtho residency? i'm amazed optometrists who pawn themselves off as ophthalmologists aren't sued more often...

Easy now. I have yet to hear of any optometrist that "pawn themselves off as ophthalmologists". That being said, I have to agree that optometry is not in any way similar to the ophthalmology sub-specialties such as cornea, retina, neuro, etc. Optometry does not fall under the unbrella of ophthalmology, it is a completely separate profession.

 

[dochopefull]

I apologize...I believe I might have worded my response a bit hastily which made it sound different than how i had intended it to sound.

What I meant to say, was that all these sub-categories fall under ophthalmology...ophthalmologists, optometrists, and even opticians in some hospitals where I have worked in. I'm sorry if i made it seem that optometry is a sub-specialty of some sort....i certainly know it is a different profession, but it does fall under ophthalmology.

Ophthalmologists are the ones who can break down into sub-specialties (cornea, glaucoma, etc...)

But I still feel that the OPs optometrist is not trying to make herselves appear to be an ophthalmologist...but rather to denote what field she is in.

Sorry for the mixup!!

D

 

[Mirror Form]

The issue to me is that my wife's referral always says "Dr X Ophtho", but she always see "Dr. Z Opto". In my wife's defense, the doctor's pictures in the waiting room simply has their name under them as "Dr. X", without the initials as to what kind of doctor they are. I only figured it out when I saw her picture myself and questioned it because she was way too young to be an ophtho...looked 25 max!!

So I certainly don't question the capability of an opto if they are truly qualified to do these exams, but I just don't like them passing her off as an ophtho!!

This happens very commonly, and I'm a bit skeptical that OD's aren't intentionally letting patients think they're medical doctors. Even if the OD is completely qualified to do the exam, the patient should know who they are seeing.

 

[VA Hopeful Dr]

Something that runs somewhat parallel to what dochopefull is saying: optometrists and ophthalmologists both use the same CPT and ICD-9 codes. In the Medicare Providers Manual, these are listed as ophthalmology codes. In this sense, optometrists do work under the umbrella of opthalmology. I have also seen ODs working in the Department of Ophthalmology in some hospitals. This might be where the confusion lies.

 

[Mirror Form]

Evidently your wife's endocrinologist has faith in the ability of the OD, otherwise he wouldn't have sent her there.

Actually, the referral states that she's supposed to see Dr. so and so, ophthalmologist. So the endocrinologist probably doesn't know that the ophthalmologist isn't seeing the patients. Therefore, part of the blame of the confusion over whether the care provided is an OD or MD is partially the MD's fault too. This isn't a situation where the patient's care was affected since the OD should be capable of screening for diabetic eyes changes. However, I just think that it's inappropriate for a patient to be seen by a care provider w/o knowing what kind of a health care provider they are.

 

[rpames]

I totally agree that ODs are not ophthalmologist, but I also think it is ridiculous to expect ODs to enter the exam room and say, "Hi, I'm Dr. X. I see you are here for Y. I am completely capable and qualified to do this exam/procedure, but just so you know, I am an optometrist." If this what is expected, then ophthalmologist should do the same thing. Should we all carry our license in our pocket and present all our credential to all our patients? If a patient asks me about it, I make it very clear what the difference is, but I feel no obligation to explain it to them unless they ask.

 

[corpsmanUP]

I have seen my wife's chart, and the consultation letter comes back from the OD, not the DO ophtho. But the insurance billing is definitely billed under the DO ophtho because the OD's name has never been on a bill. I just have a problem with paying for specialty physician level of care and getting an OD level of care for a problem that clearly deserves a physician evaluation. If diabetic eye exams were simple, they could be done by an FP with a panoptic scope. No offense, but my wife will be seeing the person with greater than 4 years of devoted eye training, and not the person with potentially one solid year of eye training. I mean who would you want to fix your wife's calcaneal fracture, the podiatrist with one year of residency training or the ortho foot doctor with greater than 5- years of surgical training and one to 2 devoted to feet?

What it sounds like to me is that the DO is risking his reputation as a specialist for a dollar because he is getting paid for an OMD level of care provided by his much cheaper OD. Its nothing different than what a PA does for an FP except that the patients are more informed since the PA obviously won't be introducing themselves as a doctor. I personally would not send further business to a specialist who billed my patient for the care done by an allied health provider. To me it is basically fraud.

 

[brendang]

I totally agree that ODs are not ophthalmologist, but I also think it is ridiculous to expect ODs to enter the exam room and say, "Hi, I'm Dr. X. I see you are here for Y. I am completely capable and qualified to do this exam/procedure, but just so you know, I am an optometrist." If this what is expected, then ophthalmologist should do the same thing. Should we all carry our license in our pocket and present all our credential to all our patients? If a patient asks me about it, I make it very clear what the difference is, but I feel no obligation to explain it to them unless they ask.[/QUOTE]

So the fact that I'm only a scutmonkey prelim on medicine right now means that I can "pawn" myself off to family members and other alike as an attending? Yes, I'm a physician; No I really don't know much, but I feel that it would be a grave injustice to introduce myself without mentioning that I'm part of the team, and specifically my role as an intern/resident... I'm not blaming you personally for your apathy towards self-distinction as an optometrist... It's the field as a whole that has this apparent insecurity about it's relative position in the grand scheme of medicine... Why NOT just say, "Hi. I'm Dr. so-and-so and I'm an optometrist..." Be proud of what you are... Say something besides "assuming" the patient won't know, or care to know the difference... That is most definately misleading.





and no... optometrists should not be doing surgery.

 

[Ben Chudner]

Why NOT just say, "Hi. I'm Dr. so-and-so and I'm an optometrist..." Be proud of what you are... Say something besides "assuming" the patient won't know, or care to know the difference... That is most definately misleading.

And when you write an Rx for glasses and contact lenses, make sure you say "by the way, I know my tech who has no formal training came up with this prescription for you, but I am sure it will work." After all assuming that the patient won't know, or care to know the difference is also misleading.

 

[corpsmanUP]

I totally agree that ODs are not ophthalmologist, but I also think it is ridiculous to expect ODs to enter the exam room and say, "Hi, I'm Dr. X. I see you are here for Y. I am completely capable and qualified to do this exam/procedure, but just so you know, I am an optometrist." If this what is expected, then ophthalmologist should do the same thing. Should we all carry our license in our pocket and present all our credential to all our patients? If a patient asks me about it, I make it very clear what the difference is, but I feel no obligation to explain it to them unless they ask.

Perhaps this is realistic in an OD only practice where patients know they are being seen by the OD and schedule with the OD. But when an OD gets all their patients from the physician when the patient thought they were sent to see an ophthalmologist, I think a detailed introduction is required. If you can't see the problem with my wife's situation after this much explaining then you should simply retire now before you harm someone.

 

[VA Hopeful Dr]

I have seen my wife's chart, and the consultation letter comes back from the OD, not the DO ophtho. But the insurance billing is definitely billed under the DO ophtho because the OD's name has never been on a bill. I just have a problem with paying for specialty physician level of care and getting an OD level of care for a problem that clearly deserves a physician evaluation.

You pay the same (90% of the time) no matter if an OD or an MD/DO examines you. Some insurance plans are different, but all of the big ones reimburse ODs and MD/DOs the same.

If diabetic eye exams were simple, they could be done by an FP with a panoptic scope.

FPs are not trained to recognize/evaluate eyes past the surface (pink eye and the like), ODs are. Would you go see an ophthalmologist to manage a systemic disease? No, you'd go to your FP or an internist. Same way you can go to either an OD or an ophthalmologist about your eyes.

No offense, but my wife will be seeing the person with greater than 4 years of devoted eye training, and not the person with potentially one solid year of eye training.

One of the nice things about ODs is that the majority of them know when something is out of their league and will refer appropriately. This is especially true if the OD is in practice WITH ophthalmologists.

What it sounds like to me is that the DO is risking his reputation as a specialist for a dollar because he is getting paid for an OMD level of care provided by his much cheaper OD. Its nothing different than what a PA does for an FP except that the patients are more informed since the PA obviously won't be introducing themselves as a doctor. I personally would not send further business to a specialist who billed my patient for the care done by an allied health provider. To me it is basically fraud.

This is actually, at least in my experience, a fairly common practice. There's two reasons that billing is done this way.
1. Right out of school, ODs typically are not providers for ANY insurance. But, they can work under the supervision of a credentialed provider and bill under that provider's license.
2. If the OD is a salaried employee of the MD, often times the MD will bill everything under his name and then just pay the OD a set hourly rate.

Perhaps this is realistic in an OD only practice where patients know they are being seen by the OD and schedule with the OD. But when an OD gets all their patients from the physician when the patient thought they were sent to see an ophthalmologist, I think a detailed introduction is required. If you can't see the problem with my wife's situation after this much explaining then you should simply retire now before you harm someone.

I think you fail to see an important factor here. For common problems (cataracts, glaucoma, diabetic problems), ODs usually provide equivalent care when compared to MD/DOs. If you truly feel that you were duped, talk to the endocrinologist. If he/she feels that an OD is good enough for your wife, then stick with your current eyecare provider. If your endocrinologist says "whoa, I thought I was sending you to an MD/DO, an OD isn't who I think you should see", then certainly follow her advice.

 

[Ben Chudner]

Perhaps this is realistic in an OD only practice where patients know they are being seen by the OD and schedule with the OD. But when an OD gets all their patients from the physician when the patient thought they were sent to see an ophthalmologist, I think a detailed introduction is required.

I think it would be very weird to come into a room and say "Hi, I'm Dr. X and I'm an optometrist". This isn't an AA meeting. However, I do think if you believed you were being referred to an MD, then the practice is at fault. When I worked for a group MD/OD practice, we listed every doctor with either OD or MD after our name on the door. The letterhead had our names down the left side separated by specialty. I was listed under optometry and low vision.

If you can't see the problem with my wife's situation after this much explaining then you should simply retire now before you harm someone.

Isn't nice how these threads always end up with comments like this. While the ophthalmologist may have acted in a way that could be considered unethical, I am sure the OD was qualified to examine your wife's eyes. It is attitudes like this that continue to strain the tenuous realtionship between our two professions.

 

[corpsmanUP]

I think it would be very weird to come into a room and say "Hi, I'm Dr. X and I'm an optometrist". This isn't an AA meeting. However, I do think if you believed you were being referred to an MD, then the practice is at fault. When I worked for a group MD/OD practice, we listed every doctor with either OD or MD after our name on the door. The letterhead had our names down the left side separated by specialty. I was listed under optometry and low vision.

Isn't nice how these threads always end up with comments like this. While the ophthalmologist may have acted in a way that could be considered unethical, I am sure the OD was qualified to examine your wife's eyes. It is attitudes like this that continue to strain the tenuous realtionship between our two professions.

I think it is very reasonable to expect the OD to introduce themselves as an optometrist. In fact, my bet is that if a complaint were made to the state optometry board, that there would be action taken in my wife's case. She had a referral to see a DO ophtho. She was instead given an appointment with someone who walks around with the title "Dr. Z" without one trace of proof she is an OD. The bill from the physician is sent to the insurance without one trace of evidence that my wife was seen by the OD. I know plenty of ophtho's that would beg to differ that they provide a higher standard of care when it comes to diabetic eye exams (yes even routine ones). I believe that most ophtho's probably do not hire OD's, and those that do mostly use them for vision. Perhaps some OD's provide stellar care and are completely capable of doing routine diabetic eye exams, but the standard of care is an ophthalmological eye exam annually for type I diabetics. I really don't care about tenuous relationships since I don't now will I ever work in this field. I am simply a consumer, and as an educated one, I will simply seek out the ophthalmologist for my wife. Its a matter of qualifications, and no matter how you want to twist things on this PHYSICIAN forum, there is no one here other than yourselves that is going to believe that you are equally qualified to diagnose diabetic retinopathy. No one cared to comment on my Podiatry example perhaps because it makes SENSE. If you want to practice medicine, then you should go to medical school. I of all people can understand and empathize with you coming from a background as a PA, but I NOW know the difference between being "qualified" to do something and being "superiorly qualified" to do something. Its all about the years you put in. And if these OD's were so equally qualified, they wouldn't have to pass them off as physicians and sneak patients in to see them under the guise of physician referrals and backdoor billing practices. I wish more ophtho's would have commented on this thread but evidently they have all been run off from their own forum by a group of hypersensitive reactionary OD's. So if you are an OD, please refrain from commenting further as I will only ignore your posts. I came hear to get the opinions of ophtho's and I will wait however long to hear more of THEIR opinions.

 

[VA Hopeful Dr]

the standard of care is an ophthalmological eye exam annually for type I diabetics.

Before you ignore my post, I, like yourself, am a medical student so I won't possess any of the "hypersensitive reactionary" traits that you believe the OD posters on this forum have.

As has been stated previously in this thread, the American Diabetic association has this to say about eye exams:

http://www.diabetes.org/whos-who-on-your-health-care-team/your-health-care-team.jsp

"Eye Doctor
This doctor is another key member of your health care team, because diabetes can affect the blood vessels in the eyes. When eye problems are caught early, there are very good treatments.


The eye doctor will be either an ophthalmologist or an optometrist.

The American Diabetes Association guidelines say you should see your eye doctor at least once a year. These checkups are the best way to detect diabetic eye disease. Your eye doctor will check for any changes in your eyes. If there are changes, the doctor will treat the problem or refer you to another doctor with special training in that area. Be sure your eye doctor is familiar with how to spot and treat diabetic eye disease.

It's a good idea to ask:

* How many of your patients have diabetes?
* Do you perform eye surgery?
* Will you send regular reports to my primary care or diabetes physician?"

So you're saying the American Diabetic Association doesn't know the standard of care for type 1 diabetes?

And if these OD's were so equally qualified, they wouldn't have to pass them off as physicians and sneak patients in to see them under the guise of physician referrals and backdoor billing practices.

I addressed that earlier as well. Seriously, just talk to your wife's endocrinologist and say "Did you mean to send my wife to an optometrist?" Its entirely possible that he/she knew you were going to be seen by an OD. If your endo. didn't know you were being seen by an OD, then its entirely possible something strange is going on. Until you know that, however; its a bit reactionary to automatically assume that the Eye Center is using all kinds of shady tactics on you.

 

[Ben Chudner]

I see the God Complex is alive and well.

In fact, my bet is that if a complaint were made to the state optometry board, that there would be action taken in my wife's case. She had a referral to see a DO ophtho. She was instead given an appointment with someone who walks around with the title "Dr. Z" without one trace of proof she is an OD.

Actually, this is untrue. There would be no action because the OD provided the appropriate care. I would bet, however, that the actual referral was for a retina evaluation and not specific as to which provider was to perform the eval.

The bill from the physician is sent to the insurance without one trace of evidence that my wife was seen by the OD.

This is due to the insurance company. If it requires billing under the facility rather than a specific provider, then the DO may be the name listed for that facility.

but the standard of care is an ophthalmological eye exam annually for type I diabetics.

Actually, this is untrue as well. The standard of care is an annual dilated eye exam by an MD/DO or an OD

Its a matter of qualifications, and no matter how you want to twist things on this PHYSICIAN forum, there is no one here other than yourselves that is going to believe that you are equally qualified to diagnose diabetic retinopathy.

I was waiting for "PHYSICIAN" to show up. Same tired arguement. I would bet that there are plenty of retina specialists that work very well with their referring OD's and have every confidence that we are equally qualified to diagnose diabetic retinopathy.

No one cared to comment on my Podiatry example perhaps because it makes SENSE. If you want to practice medicine, then you should go to medical school.

Maybe because it is not quite comparing apples to apples, and I want to practice optometry. No matter how much you are in denial, that includes peforming diabetic eye exams.

So if you are an OD, please refrain from commenting further as I will only ignore your posts. I came hear to get the opinions of ophtho's and I will wait however long to hear more of THEIR opinions.

Ignore all you want, but I think it's time you transfer your wife's care (since you have already made up your mind) and get on with your life.

 

[dochopefull]

To the OP...

Do you think your wife is getting sufficient care aside from the fact that you feel you and her have both been duped?? As long as she is not having her eyeballs melt away I think what the OD is doing is caring for your wife in the limits that she is able and required to do so in. ODs know their role where they work and if needed they will refer patients to the according MD/DO. But I think its unfair to think that ODs are not capable of diagnosing eye diseases...I mentioned this in a previous thread....but some ODs do an even better job of finding and diagnosing diseases than some MD/DOs...at least some of the ones I have worked with in the hospital. Not only do they know their stuff, but they know when it is the right time to refer a patient to someone who can give specialty care for their problem.

And about you wanting the doc to introduce him/her as Dr. X, Optometry...that is absurd. How many doc's do you know who practice this?? You probably won't even do it yourself! I know I won't unless I am asked which field I am in, and then will tell the patients. I think the patients have their own resposibility of knowing who they are actually seeing...that is not the doctor's job...they have enough to deal with as it is. If your so oblivious to knowing who the hell you are seeing, then that is not our problem or the doc's, but yours and your wife's.

If you want to ignore the posts...please do...I doubt any of us would mind missing out on your compaints.

 

[corpsmanUP]

To the OP...

Do you think your wife is getting sufficient care aside from the fact that you feel you and her have both been duped?? As long as she is not having her eyeballs melt away I think what the OD is doing is caring for your wife in the limits that she is able and required to do so in. ODs know their role where they work and if needed they will refer patients to the according MD/DO. But I think its unfair to think that ODs are not capable of diagnosing eye diseases...I mentioned this in a previous thread....but some ODs do an even better job of finding and diagnosing diseases than some MD/DOs...at least some of the ones I have worked with in the hospital. Not only do they know their stuff, but they know when it is the right time to refer a patient to someone who can give specialty care for their problem.

And about you wanting the doc to introduce him/her as Dr. X, Optometry...that is absurd. How many doc's do you know who practice this?? You probably won't even do it yourself! I know I won't unless I am asked which field I am in, and then will tell the patients. I think the patients have their own resposibility of knowing who they are actually seeing...that is not the doctor's job...they have enough to deal with as it is. If your so oblivious to knowing who the hell you are seeing, then that is not our problem or the doc's, but yours and your wife's.

If you want to ignore the posts...please do...I doubt any of us would mind missing out on your compaints.

You jerks can't even see it when someone tries to throw you a peace offering. You simply will never admit that an OD could have ever violated a patient provider relationship. But I will say it a bit more slowly for you who could not get past the MCAT. My wife had a referral to an opthalmologist. She was given an appointment with his "partner" because her schedule was open, and this "partner" had a white coat that said "Dr. X". Actually by law in my state, this is illegal. A DO, OD, MD, DVM...etc must have adequate signs and ID identifying them by their degree. I am less worried about the degree my wife's OD had and more concerned about the veil of secrecy surrounding it and the practice. But you guys go on stroking your mini egos and I will take my conversation to the doctor's lounge where you guys won't be hanging! Its sad to see when you can't even side with honesty and decency when it stares you right in the face. All you want to do it fight about titles. I could care less about titles. Hec, as a PA and a NON doctor, I was making more and getting more real respect from my patients, and I never had to hide my credentials behind some allied health "doctor" title. SO is that enough ignoring for you? For God's sake, where are the physicians when you need them!!

 

[corpsmanUP]

And about you wanting the doc to introduce him/her as Dr. X, Optometry...that is absurd. How many doc's do you know who practice this?? You probably won't even do it yourself! I know I won't unless I am asked which field I am in, and then will tell the patients. I think the patients have their own resposibility of knowing who they are actually seeing...that is not the doctor's job...they have enough to deal with as it is. If your so oblivious to knowing who the hell you are seeing, then that is not our problem or the doc's, but yours and your wife's.

You have evidently never done more than a high school tour through a real world hospital my friend. It is ROUTINE for a physician to walk into a patient's room and say "Hello Mr X, I am Dr. Soandso, one of the neurologists"...or "Hello Mr. X, I am Dr. Suchforth one of the orthopedic surgeons". This is customary and standard in my world. And in a setting where there are physicians working side by side along with OD's, it SHOULD be customary as well to say "Hello, I am Dr SOandSo, one of the optometrists". In fact, as a non-physician doctor you have an even further ethical, moral, and legal responsibility to spell out in black in white with either words or letters on your coat exactly who you are to a patient. I guarantee you licensing board thinks so in my state which is why the law is the way it is. Too busy to introuduce yourself to your patients.....? And weren't you the same people arguing that you spent more time and had better relationships with your patients? Oh to hec with that when it doesn't fit into your schematics!!

 

[dochopefull]

1) What was your wife's referral for? It will probably help to see why the MD/DO did not see her insead.

2) there is no need to quote the word partner since that is exactly what an OD is to an MD/DO.

3) Out of the 2 top ranked hospitals in the US I am doing ophthalmic research in, and the 3 others I have done work in with other fields...I can assure you that it is certainly not routine for a doctor to point out exactly what field they are in and spell out the initials after their name on the white coat they are wearing. Yes they say "Hello. I am Dr. ____" when they see a new patient but that is all. And do not think that these are docs who have no ethical judgement about how to go about clinic....these men and women are some of the most prominent docs in their field, and if anyone knows about etiquette in the clinic, they would. Once again, they assume the patients are competent enough to know where they are going. I don't know what state you are from but over here, people are that competent.

4) As for the initials, many docs do not even have their name printed on their coat, but they do wear badges with all the info a patient would want to see (name, initial, dept, etc). So perhaps their is some sort of ethical problem where you are going....but that is one place...most others are not like that.

 

[corpsmanUP]

1) What was your wife's referral for? It will probably help to see why the MD/DO did not see her insead.

2) there is no need to quote the word partner since that is exactly what an OD is to an MD/DO.

3) Out of the 2 top ranked hospitals in the US I am doing ophthalmic research in, and the 3 others I have done work in with other fields...I can assure you that it is certainly not routine for a doctor to point out exactly what field they are in and spell out the initials after their name on the white coat they are wearing. Yes they say "Hello. I am Dr. ____" when they see a new patient but that is all. And do not think that these are docs who have no ethical judgement about how to go about clinic....these men and women are some of the most prominent docs in their field, and if anyone knows about etiquette in the clinic, they would. Once again, they assume the patients are competent enough to know where they are going. I don't know what state you are from but over here, people are that competent.

4) As for the initials, many docs do not even have their name printed on their coat, but they do wear badges with all the info a patient would want to see (name, initial, dept, etc). So perhaps their is some sort of ethical problem where you are going....but that is one place...most others are not like that.

No offense dochopeful, but you are out of your element to tell anyone what goes on inside a hospital. And I would say the same even for your OD buddies who are actually either in OD school or done with it. I have the feeling you are locked away in a basement somewhere scrubbing TM plates or something. It is customary for doctors to introduce themselves and their specialty because otherwise patients would never know who is seeing them. They often have multiple specialists consulting for multiple reasons. When you actually start medical school I think you will see the irony in your comments.

 

[aphistis]

No offense dochopeful, but you are out of your element to tell anyone what goes on inside a hospital. And I would say the same even for your OD buddies who are actually either in OD school or done with it. I have the feeling you are locked away in a basement somewhere scrubbing TM plates or something. It is customary for doctors to introduce themselves and their specialty because otherwise patients would never know who is seeing them. They often have multiple specialists consulting for multiple reasons. When you actually start medical school I think you will see the irony in your comments.

That's one helluva chip on your shoulder, sport. Remember when you started this thread & you were actually looking for advice instead of OD-bashing?

 

[corpsmanUP]

That's one helluva chip on your shoulder, sport. Remember when you started this thread & you were actually looking for advice instead of OD-bashing?

True enough, but the forum is a physician forum. And its not a chip on my shoulder; its a big fat pile of bird dung because I feel that these OD's who have hijacked this PHYSICIAN forum cannot even admit when something fundamentally wrong is wrong, like when a non-physician tries to pass themself off as something that could be construed as a physician. But the worst part of it is to hear some inexperienced dimwit try and tell an experienced dimwit (see I can be objective) how things work in a hospital. Please spare me the lecture on physician introductions...God forbid. I had no intention of OD bashing, and actually still am not. Read carefully my above posts about how I would certainly use an OD to see my patients if an ophthalmologist was not readily available.

 

[dochopefull]

I never intended to start a fight and I find it surprising that a great MS4 like yourself would start using name calling to strengthen your argument, but I assure you I have worked side by side with doctors in clinic and I certainly have never heard any of them introducing themseleves with anything other than "Hello, I'm Dr. _____". And thats the last time I am going to comment about that.

You said that you know how to use ODs....well obviously you would know then that the ophthalmologist is using the OD in the right way. From your first post, you talked about your wife getting referred to have yearly dialated exams done. These exams are what ODs are specialized in doing: checking vision. I am assuming that since the OD has not sent you back to the MD/DO, your wife's vision is fortuneately stable and the diabetes is not completely wrecking her eyes. If it ever began to decrease and if surgery would be involved, I would assure you the OD would refer her to the retina doc and not try to do surgery or anything herself....whcih i hope you are not assuming.

In any case, these yearly exams your wife is supposed to be having are things that MD/DOs really do not like doing and therefore send patients to ODs to have them done anyways. Like i said, they have too much on their hands as it is rather than doing routine dialated eye exams whcih an OD is more than capable of doing. I hardly think the OD is trying to pass herself off as a physician.

However, I do agree with you that it is strange that she is walking around without initials on her coat (not sure if they also wear ID badges).

I am not trying to act like a know-it-all, but I am trying to give my take on the problem you are having after working in this field for a pretty long time. I would imagine that well known hospitals like where i am situated are as good as any to model how other places should work.

D

 

[dochopefull]

One more things....

your asking for physicians to come and help you, but to be honest, they probably dont want to deal with your bickering becasue something like that is a waste of their time and could rather be spending their time doing something much more serious.....in a similar sense that is why your wife was sent to the OD.....a routine exam is a waste of time for MD/DOs...why would they do them if they have partners who are capable of doing the exact same thing (the screening, etc). But, your wife would find herself in a retina doc's exam room the second the OD found some sign of retinopathy...that I can assure you.

Hopefully that will be the end of it.

D

 

[brendang]

One more things....

your asking for physicians to come and help you, but to be honest, they probably dont want to deal with your bickering becasue something like that is a waste of their time and could rather be spending their time doing something much more serious.....in a similar sense that is why your wife was sent to the OD.....a routine exam is a waste of time for MD/DOs...why would they do them if they have partners who are capable of doing the exact same thing (the screening, etc). But, your wife would find herself in a retina doc's exam room the second the OD found some sign of retinopathy...that I can assure you.

Hopefully that will be the end of it.

D

Dude, just give up. Whatever you say, some OD is going to twist it around and make it seem like they are perfectly suited for the job. I know it's bulls#it. You know it's bulls#it... The vast majority of patients know it's bulls#it... I'm just amazed at their frame of reference... I wish I could help you here, perhaps provide a more convincing argument, but there really is no point... This is something that has been going on for a long time and until something drastic happens (and it will), nothing is going to prevent OD's from pawning themselves off as the "real deal"... I'm sorry your wife had to go through this.

And as far as patient introductions, every single retinal surgeon I know of introduces himself/herself by his/her job title and what he/she does specifically... Hell, I'm just an intern and I explain to my patients what my role is (psss... it's because I have nothing to hide)...

 

[corpsmanUP]

Dude, just give up. Whatever you say, some OD is going to twist it around and make it seem like they are perfectly suited for the job. I know it's bulls#it. You know it's bulls#it... The vast majority of patients know it's bulls#it... I'm just amazed at their frame of reference... I wish I could help you here, perhaps provide a more convincing argument, but there really is no point... This is something that has been going on for a long time and until something drastic happens (and it will), nothing is going to prevent OD's from pawning themselves off as the "real deal"... I'm sorry your wife had to go through this.

And as far as patient introductions, every single retinal surgeon I know of introduces himself/herself by his/her job title and what he/she does specifically... Hell, I'm just an intern and I explain to my patients what my role is (psss... it's because I have nothing to hide)...

I'll be having nothing to hide next year as well!! The great thing about being an intern! You know its strange being on the other side of the physician/non-physician fence finally. I used to think like they did until I had by a$$ handed to be in a severe way when I thought being a PA would carry me through med school easily. Nothing can carry you through medical school except some good beer and prayer!!....and Advil!

Thanks for your reply though buddy, I owe you a debt of gratitiude for stepping into the crossfire. I'll let this thread die on your note, although I am sure someone will try and steal the last word. Perhaps I will just delete the whole thread if that occurs!!

 

[vanelo]

Treat your wife to a real eye doctor: MD. In 15-20 years (God help her) if something goes wrong with her eyes, I dont think any OD will be held liable.

Optos = Prescriptions technicians (not retina specialists or whatever they want to call themselves)

 

[mdkurt]

"This is actually, at least in my experience, a fairly common practice. There's two reasons that billing is done this way.
1. Right out of school, ODs typically are not providers for ANY insurance. But, they can work under the supervision of a credentialed provider and bill under that provider's license.
2. If the OD is a salaried employee of the MD, often times the MD will bill everything under his name and then just pay the OD a set hourly rate."



I hope this isn't too common. It's definitely a pain to get a new practitioner on all the insurance panels, but billing this way is seen as fraudulent. Only the physician providing the services can bill for them. That being said, your wife is responsible for knowing who is taking care of her. An optometrist is fine for diabetic screenings, but if she's uncomfortable with it she should switch.

 

[diabeticfootdr]

corpsmanUP,
There is nothing inappropriate with ODs being used to screen for retinopathy. You think a busy ophtho wants to waste their time doing routine screenings all day long when they can just be referred the patients who actually have retinopathy??

As a PA you should realize this. PAs have less training than ODs and are perfectly capable of screening for many conditions and providing appropriate referrals.

LCR

 

[f_w]

- file a request with the practice to receive a copy of your wifes entire file
- go through it, check who wrote the notes for the visits and whether they where countersigned by the DO/MD who issued the bill (to show in a medicolegal sense that he/she takes responsibility for the midlevels work).
- go to your health insurance company and talk to their compliance department about this. If they are ok with paying bills from providers who are not on their roster, there is nothing you can do. If they are not, they might go after the practice for these billing irregularities (I could say systematic billing fraud, but that would get me flamed).

- have her see an ophthalmologist specializing in 'medical retina' (a retina trained ophtho who doesn't operate). Checking diabetics is one of the things they live on. And yes, I do believe that specialization is a good thing, someone who does this all day long might see subtle changes the primary care level provider could have missed.

 

[corpsmanUP]

corpsmanUP,
There is nothing inappropriate with ODs being used to screen for retinopathy. You think a busy ophtho wants to waste their time doing routine screenings all day long when they can just be referred the patients who actually have retinopathy??

As a PA you should realize this. PAs have less training than ODs and are perfectly capable of screening for many conditions and providing appropriate referrals.

LCR

For God's sake Pod man, did you read anything past the original post? Within a couple of replies we moved past the part where I was questioning the ability of the OD to do the exam, and I was focusing on the fact that the practice passed the OD off as the ophthalmologist basically. My complaint if you would have read the follows ups was that the referral was made to OPHTHO and the fact that my wife thought she saw one.

I even commented on the fact that the use of a PA is similar, except for one exception. PA's are not doctors and thus it is quite obvious when the patient is introduced to the PA that they are NOT the physician. The same would be a problem if an ortho practice hired you to see feet for them to take the strain off them. Then when the patient is referred to ortho for their bunion, you instead get the appointment and then walk in with only a white coat saying Dr. X. The bill goes through the ortho practice, and the insurance reimburses the practice who pays you hourly for your services. Your business card simply says "Dr. X", foot and ankle surgeon. The patient goes home thinking they saw the ortho doctor and I suppose if you think like these OD's on this thread you would think that is all cosher.

That is what this thread has become. Now hopefully you will read the other posts and figure out that you are about 30 replies behind.

 

[ddown]

CorpsmanUP,

I was following your argument until you decided to drop the "for those who couldn't get past the MCAT" crap. It kills your credibility. Weren't you once a PA? Surely, as a PA you "couldn't get past the MCAT, right? Now you are very close to your M.D. degree. I can guarantee you there are many ODs, PharmDs, DMDs, and so forth that were, or could have been, granted admission to both allied health and medical programs and chose the former for various reasons. Arguing whether or not the OD should have to formally state his/her degree is one thing but attacking someone's intelligence based on that degree is quite another.

For God's sake Pod man, did you read anything past the original post? Within a couple of replies we moved past the part where I was questioning the ability of the OD to do the exam, and I was focusing on the fact that the practice passed the OD off as the ophthalmologist basically. My complaint if you would have read the follows ups was that the referral was made to OPHTHO and the fact that my wife thought she saw one.

I even commented on the fact that the use of a PA is similar, except for one exception. PA's are not doctors and thus it is quite obvious when the patient is introduced to the PA that they are NOT the physician. The same would be a problem if an ortho practice hired you to see feet for them to take the strain off them. Then when the patient is referred to ortho for their bunion, you instead get the appointment and then walk in with only a white coat saying Dr. X. The bill goes through the ortho practice, and the insurance reimburses the practice who pays you hourly for your services. Your business card simply says "Dr. X", foot and ankle surgeon. The patient goes home thinking they saw the ortho doctor and I suppose if you think like these OD's on this thread you would think that is all cosher.

That is what this thread has become. Now hopefully you will read the other posts and figure out that you are about 30 replies behind.

 

[gerido]

CorpsmanUP,

I was following your argument until you decided to drop the "for those who couldn't get past the MCAT" crap. It kills your credibility. Weren't you once a PA? Surely, as a PA you "couldn't get past the MCAT, right? Now you are very close to your M.D. degree. I can guarantee you there are many ODs, PharmDs, DMDs, and so forth that were, or could have been, granted admission to both allied health and medical programs and chose the former for various reasons. Arguing whether or not the OD should have to formally state his/her degree is one thing but attacking someone's intelligence based on that degree is quite another.

I completely agree! It's usually the ones who feel insecure about their own numbers that use it to bash someone else.

I had no intention of OD bashing, and actually still am not.

Complete bull****! Your bickering definiately shows your concern for your wife and I'm sure you didn't make this post to make a dumb point.

 

[diabeticfootdr]

That is what this thread has become. Now hopefully you will read the other posts and figure out that you are about 30 replies behind.

I didn't know SDN had a rule requiring a "poster" to only comment on the previous post???? I'm sorry I'm busy (reconstructing diabetic limbs with Ilizarov) and don't have the time to "live on SDN" and wait for every word to come off your fingertips.

Perhaps after you actually become a doctor and your arrogance embarrasses you in the presence of other heath professionals - (OD, DPM, DDS, DO), you will be humbled and respect them for their own place in medicine.

LCR

 

[corpsmanUP]

I didn't know SDN had a rule requiring a "poster" to only comment on the previous post???? I'm sorry I'm busy (reconstructing diabetic limbs with Ilizarov) and don't have the time to "live on SDN" and wait for every word to come off your fingertips.

Perhaps after you actually become a doctor and your arrogance embarrasses you in the presence of other heath professionals - (OD, DPM, DDS, DO), you will be humbled and respect them for their own place in medicine.

LCR

I am only embarrassed to be on the same thread with someone who measures their worth by who they are molding rubber feet with. Get over your own arrogance prior to debating mine. These OD's wasted several posts worth of rhetoric when they simply should have admitted that my wife had been treated incorrectly. Darn straight I will comment however I please if someone avoids the obvious mistreatment of one of my relatives and simply attacks my desire to bring it to the attention of others. Not once did one of these OD's try and say that what happened to my wife was incorrect. Well my friend, not only was it wrong and unethical, but it was illegal. Our state has very specific practice laws for non-physicians, and it was violated here. But once again, feel free to get pissed at the "physician" side of the argument no matter how repugnant the other side acts right? You are no more a physician than they are nailcutter, and thus I guess that is the reason you really took offense. You should be happy when someone questions the credibility of the "doctor" they are seeing as it shows they are involved in their care. And for the record, I have no problem with Pods. My wife has a great one for her routine foot care. He though wears the letters DPM on his coat and has a sign on his door that says Podiatric Foot and Ankle Surgeon. Being upfront and honest about your credentials will get you much further than hiding them for your own embarrasing sake. And that was what my argument was about. And personally, I won't lose sleep if you think my credibility is lost. This is my freaking thread and I will take it in any direction I choose.

 

[VA Hopeful Dr]

Our state has very specific practice laws for non-physicians, and it was violated here.

This may be getting a bit picky, but can you quote exactly which law was violated and explain to me how it was? I'm not trying to argue or demean your point, I'm honestly curious and feel this is something worth knowing.

Thanks in advance

 

[Ben Chudner]

I am only embarrassed to be on the same thread with someone who measures their worth by who they are molding rubber feet with. Get over your own arrogance prior to debating mine.

Mature

These OD's wasted several posts worth of rhetoric when they simply should have admitted that my wife had been treated incorrectly.

Your wife was not treated incorrectly. Even you have said you are not arguing whether ot not the OD is qualified to perform a diabetic eye exam.

Darn straight I will comment however I please if someone avoids the obvious mistreatment of one of my relatives and simply attacks my desire to bring it to the attention of others. Not once did one of these OD's try and say that what happened to my wife was incorrect. Well my friend, not only was it wrong and unethical, but it was illegal. Our state has very specific practice laws for non-physicians, and it was violated here.

I am curious... in which state is it illegal for an optometrist to perform a dilated eye exam to rule out retinopathy? I would also know in which state is it illegal for an office to make an appointment with an OD for a patient that was referred for a diabetic eye exam. Even if the PCP stated in the referral that your wife was to be seen by an ophthalmologist, there is no law that I know of that requires that ophthalmologist to see the patient instead of having one of his/her associate doctors (OD or MD) perform the exam. Unethical and wrong, that's open to interpretation (I think it is unethical if the PCP wanted the DO to see your wife), illegal, you will have to provide the specific statute to convince me.

 

[f_w]

E.g. the laws of the state of Maine:

Title 32: PROFESSIONS AND OCCUPATIONS
Chapter 48: BOARD OF LICENSURE IN MEDICINE (HEADING: PL 1993, c. 600, Pt. A, @197 (rpr))
Subchapter 2: LICENSURE (HEADING: PL 1993, c. 600, Pt. A, @203 (rpr))

§3270. Licensure required

For physicians:

... An individual licensed under chapter 36 may prefix the title "Doctor" or the letters "Dr." to that individual's name, as provided in section 2581.....

And later for optometrists and podiatrists:

.........or an optometrist duly licensed under the laws of this State may prefix the title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word "Optometrist" or a podiatrist licensed under the laws of this State may prefix the title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word "Podiatrist" or "Chiropodist.".......

........Whoever, not being duly licensed by the board, practices medicine or surgery or a branch of medicine or surgery, or purports to practice medicine or surgery or a branch of medicine or surgery in a way cited in this section, or who uses the title "Doctor" or the letters "Dr." or the letters "M.D." in connection with that individual's name, contrary to this section, commits a Class E crime .................


At least in Maine, it looks like you have to explicitly tell your patients that you are an optometrist and not a physician.

 

[dochopefull]

I'm not really sure what the OP wants from us....he asked whether or not it was right that his wife was having her yearly eye exam and being screened for diabetic retinopathy by an OD who had special training in screening for it....not treating it. (I said this before but i guess you didnt get it...if she needed to be treated for it, she would be in the MDs room in a flash.)

Your answer: YES! It is right for your the OD to be checking your wife! And yes, there are ODs who have extra training to check for those.

He then went on to ask whether or not it was right for the OD to not have the initials next to her name or whatever on her coat....no, i agree with you that it is not ethical. But does she have a badge? I asked you that before and you never answered...Usually they have badges as well, and on it will state what your licensure is. If that is the case then the doc is not breaking the law. (to the previous poster...thanks for clearing it up about the law...i bet its like that in most places....but it does not explicitly mention telling the patient anything as long as you have it written on a badge or a white coat)

If this is such a problem for you....stop complaining and change the doc. It'll be funny when the next MD sends you back to an OD for the screening. I assure you, its a part of the field that they do not enjoy dealing with since they have associates who can take care of that, and who are very good at it as well (for the most part).

D

 

[Ben Chudner]

And later for optometrists and podiatrists:

.........or an optometrist duly licensed under the laws of this State may prefix the title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word "Optometrist" or a podiatrist licensed under the laws of this State may prefix the title "Doctor" or the letters "Dr." to that individual's name when accompanied by the word "Podiatrist" or "Chiropodist.".......

........Whoever, not being duly licensed by the board, practices medicine or surgery or a branch of medicine or surgery, or purports to practice medicine or surgery or a branch of medicine or surgery in a way cited in this section, or who uses the title "Doctor" or the letters "Dr." or the letters "M.D." in connection with that individual's name, contrary to this section, commits a Class E crime .................


At least in Maine, it looks like you have to explicitly tell your patients that you are an optometrist and not a physician.

If the OP is in Maine, and the office had the OD's name as Dr. X without the word optometrist, then I would agree the optometrist violated the law.

 

[diabeticfootdr]

I am only embarrassed to be on the same thread with someone who measures their worth by who they are molding rubber feet with.

It's not WHO you *****. Dr. Ilizarov is dead. Ilizarov is a method of ring fixation.

 

[Andrew_Doan]

I've been following this thread, and I must say something because it is getting out of hand... yet again. Please be respectful.

In regards to optometrists performing diabetic screenings, this is how a competent eye professional network works. OD sees patient and follows them until there are problems. Then appropriate referral is then done. As an ophthalmologist, I'd rather not fill my clinic with 30 normal patients every day. Optometrists are trained and can recognize diabetic changes in the eye. This is part of the OD's scope of practice. To argue otherwise is being unreasonable.

 

[f_w]

Whether OD's are qualified to DO the exam is not so much the issue here. Except for some hotheads here, nobody would doubt that a properly trained OD can do these.

It is the bait and switch method of taking referrals to the MD/DO in the practice, and shunting them to an OD without explicit consent of the patient. And to top this off, bill out the service under the MD/DO's name as if he/she had performed the service (don't try that with medicare, the federal minimum security prisons are full of people who had 'innovative' billing concepts).

 

[dochopefull]

I've been following this thread, and I must say something because it is getting out of hand... yet again. Please be respectful.

In regards to optometrists performing diabetic screenings, this is how a competent eye professional network works. OD sees patient and follows them until there are problems. Then appropriate referral is then done. As an ophthalmologist, I'd rather not fill my clinic with 30 normal patients every day. Optometrists are trained and can recognize diabetic changes in the eye. This is part of the OD's scope of practice. To argue otherwise is being unreasonable.

Thanks Dr. Doan

 

[corpsmanUP]

It's not WHO you *****. Dr. Ilizarov is dead. Ilizarov is a method of ring fixation.

I now take offense to your comments. I thought before this that you were just incoherent when it came to reading the entire thread. But now you decide to actually resort to calling me names. And because I don't know who your little Podiatry God is? Please, I would venture to say that maybe 1% of physician's have ever heard of him, and possibly 10% of ortho docs. But thats how you non-physician specialists think everything works. You think because we physicians don't have the same degree of knowledge that you do about one small area of the body that we are somehow unworthy. Thats the whole problem with non-physician specialists. How can you expect anyone to really consider you a physician when you have little real training on the remainder of the body above say the tibial tubercle (and that is being way generous and you know it). Well I have news for you PodDoc, the only limbs I really believe you are making any difference about are the ones that fall into your backyard above-the-ground pool. This entire thread was about the "bait and switch" issue regarding non-physicians being swapped out for physicians. And I am even dissappointed that our resident MD forum moderator did not even care to comment about this. I had no knowledge of whether or not the OD was capable of screening this condition or not, but when I heard from many of you that they were, I stopped harping on that. I instead took the conversation thr route of the " bait and switch instead, which to me was just unethical. Pod doc jumped in a day late and a dollar short with an attitude to boot. And it was the typical " run to the non-physician specialist's" defense that brought him, because he obviously care nothing about the real issue that had been being discussed regarding the bait and switch.

I am done with this forum, and every time you NPS's open your traps you piss off about 10 potential referring docs because everyone who reads these threads hears the desperation in your words. Coming from a PA, I can tell you that I never thought that I was more capable than a physician, equally capable as a physician, or even equally in the same league with one on a professional status level. I suggest that you NPS's consider accepting the same fact about yourselves and start being a bit more humble if you really want any business in the future. If I can smell you from across the PC world, you know your neighbor physicians can smell your "I am equal to you" attitude a mile away. You would think you would just be happy making good money, getting called doctor, and making a difference in patient's existences. But no, you have to always try and convince someone as to why you can do the physician's job just as well as they can. Add that to 50 cents and you can buy a condom off a pub's bathroom wall!!!

I is officially DUN with this thread. And thanks for the backup moderator....I am guessing you hire a few OD's yourself.