Optometry scope: a help or a hindrance?

[VA Hopeful Dr]

It's not that this is a huge issue in and of itself. It's scope creep. It starts out as we need XYZ to be more effective or to treat the underserved, in the end it's cosmetics and lasers aimed at the upmarket. The people who are being benefitted can afford to wait, it's nonessential. If not you wind up with what we have in FL for pods, the scope creep started small and now is knees on bone and the hip on flesh. Compare this to the rest of the nation where it's the ankle. Or look at the OK case, it's all the same issue at heart.

Lasers aimed at the upmarket? What does that mean?

I guess we'll just have to agree to disagree. I don't see ODs using a drug they've been using for 10 years in a slightly different way as any change in scope.

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[FutureCTDoc]

Lasers aimed at the upmarket? What does that mean?

I guess we'll just have to agree to disagree. I don't see ODs using a drug they've been using for 10 years in a slightly different way as any change in scope.

As in eventually for LASIK and PRK. I would be more amenable to this change if this were medically necessary, for cosmetics I don't see the need and the burden of proof is on the ODs to show there is need. I guess we'lll just have to as you as said agree to disagree.

 

[KHE]

Because it's a cosmetic procedure, there is no justification for this and this is an unmerited expansion of scope. Since ODs want this, they should be forced to have a compelling reason as to why.

See, if you view it as an "expansion of scope" to prescribe a medication that we already have been prescribing for a number of years, then I guess there's nothing left to talk about.

And that's why ODs continue to fight. You obviously will fight against it and that's fine. But it's about controlling destiny. Not blepharoplasties and LASIK.

 

[PBEA]

derm and plastic/cosmetic surgeons are the most prominent prescribers of Latisse (from a rep) and, imo, they are the least qualified to do so. This is why ODs continue to fight the double tongue MD, who sees this as encroachment on their money, and has NOTHING to do with pt safety. I'm sure you will try and bar ODs from ANY new tx, regardless of any perceived "risk". "Patient safety" ends up being little more then a soundbyte to rally the troops. Your credibility is lacking, your motives transparent, and your ethics are questionable. These kinds of discussions only lead to greater mistrust of MDs. You ARE lying.

 

[VA Hopeful Dr]

As in eventually for LASIK and PRK. I would be more amenable to this change if this were medically necessary, for cosmetics I don't see the need and the burden of proof is on the ODs to show there is need. I guess we'lll just have to as you as said agree to disagree.

No, the burden on ODs is to show that they can do it safely. Need has nothing to do with it.

 

[VA Hopeful Dr]

derm and plastic/cosmetic surgeons are the most prominent prescribers of Latisse (from a rep) and, imo, they are the least qualified to do so. This is why ODs continue to fight the double tongue MD, who sees this as encroachment on their money, and has NOTHING to do with pt safety. I'm sure you will try and bar ODs from ANY new tx, regardless of any perceived "risk". "Patient safety" ends up being little more then a soundbyte to rally the troops. Your credibility is lacking, your motives transparent, and your ethics are questionable. These kinds of discussions only lead to greater mistrust of MDs. You ARE lying.

I do wish you'd quit generalizing. Most MDs don't care what ODs do, and some of us are actually pretty friendly to you guys' cause.

Saying things like what you and Meibomian SxN say have the effect of making that last group question why we should continue to think that way when you guys continue to insult us.

 

[PBEA]

of course you are correct, but I've had my fill of politically motivated, unproven claims that many MDs make with regard to Optometrists. Its one thing to say that ODs don't receive sufficient training in surgery, its a whole nother ballgame when someone acccuses ODs of "using legislation to the exclusion of education" when discussing the use (of all things) Latisse. I've used it a grand total of 2 times, both on alopecia cases with limited results (one dropped it for cost), and the other saw little improvement. Meanwhile the cosmetic guys are tossing it willy-nilly (yes I said willy-nilly) at anyone who sees the banner ad on their website. I'm waiting for the damn thing to show up in nail salons, the way colored cl's have.

BTW, do you have a link to the OD group in your home state, that you say is putting up wet labs for OD's wanting to practice surgery.

 

[VA Hopeful Dr]

of course you are correct, but I've had my fill of politically motivated, unproven claims that many MDs make with regard to Optometrists. Its one thing to say that ODs don't receive sufficient training in surgery, its a whole nother ballgame when someone acccuses ODs of "using legislation to the exclusion of education" when discussing the use (of all things) Latisse. I've used it a grand total of 2 times, both on alopecia cases with limited results (one dropped it for cost), and the other saw little improvement. Meanwhile the cosmetic guys are tossing it willy-nilly (yes I said willy-nilly) at anyone who sees the banner ad on their website. I'm waiting for the damn thing to show up in nail salons, the way colored cl's have.

BTW, do you have a link to the OD group in your home state, that you say is putting up wet labs for OD's wanting to practice surgery.

Its not hard to just ignore people saying mean things about you. Further, the only person here who's said anything about Latisse is the incoming M1 student.

I sent you a PM about that last.

 

[Visionary]

Dear SDN Moderator,

Please lock this thread. It has degenerated into a useless p***ing contest.

 

[Meibomian SxN]

If you're going to try and use an article, I'd suggest you actually READ the article next time. PA student =/= medical student. (Good catch CT)

And please stop bashing medical students. You're a practicing OD, I'd have thought such behavior was beneath you. You don't see any MDs going out of their way to insult OD students.

Opps, my +1.00 readers failed me; hehehe! 😎

 

[DKofLV]

Opps, my +1.00 readers failed me; hehehe! 😎

That wasnt an intentional neglect of information to make people think it was MD students that did that? Also, you have become the **** stirrer you used to stand up against...

anyways....yes...PLEASE LOCK THIS THREAD...it's turned into EXACTLY what we warned against in the beginning...ignorant MD students arguing one point, ODs arguing another, and OMDs standing in between telling both sides to get with the program...it provides no positive conversation...

 

[odieoh]

No, the burden on ODs is to show that they can do it safely. Need has nothing to do with it.

You epitomize the overzealous side of the OMD/OD turf war. In the overall argument against expansion of scope, safety and patient care are certainly important, but come on, we are talking about ***king Latisse here. As several have already pointed out, optoms are already allowed to use this medication for much more serious conditions. You are making yourself look very silly by trying to turn it into a safety issue. What exactly do you propose they do to "show that they can do it safely"?

Originally Posted by FutureCTDoc
Because it's a cosmetic procedure, there is no justification for this and this is an unmerited expansion of scope. Since ODs want this, they should be forced to have a compelling reason as to why.

Again, its Latisse. . . if you want the optoms to provide a compelling reason why they should be able to use it, us MD's should also provide a compelling reason. My compelling reason is $$$. I'm not a money grubbing greed *****, I think I practice medicine for the right reasons, but come on, lets call things like they are. How many people are you treating with Latisse because they are emotionally devastated over their "lash insufficiency?" What is your compelling reason to be able to use it? It's a low risk topical med for cosmetic use and it is perfectly reasonable for optoms to use it.

In the turf war sometimes it would be really refreshing if people simply acknowledged that a lot of it IS simply a turf war and got off their patient safety high horse. I can respect someone wanting to protect their turf. I can't respect someone pretending that everything is a safety issue.

 

[orbitsurgMD]

Opps, my +1.00 readers failed me; hehehe! 😎

And be sure not to confuse them with the +0.75 "computer" glasses.

 

[KHE]

And be sure not to confuse them with the +0.75 "computer" glasses.

Computer glasses would need 1/2 to 1 prism diopter of base in prism.

 

[Meibomian SxN]

Computer glasses would need 1/2 to 1 prism diopter of base in prism.

No need for prism, I'm an Optometrist! I just do my calculations & adjust my PDs for that prismatic effect

 

[DOCTORSAIB]

No need for prism, I'm an Optometrist! I just do my calculations & adjust my PDs for that prismatic effect

You are? Why does your title say attending?

 

[VA Hopeful Dr]

You epitomize the overzealous side of the OMD/OD turf war. In the overall argument against expansion of scope, safety and patient care are certainly important, but come on, we are talking about ***king Latisse here. As several have already pointed out, optoms are already allowed to use this medication for much more serious conditions. You are making yourself look very silly by trying to turn it into a safety issue. What exactly do you propose they do to "show that they can do it safely"?
.

Try reading better. I'm fully behind ODs Rxing Latisse as its a drug they have been using for quite some time. My statement that you quoted as in direct response to another poster trying to justify not allowing ODs to write for it on the basis that it is a cosmetic drug in this formulation.

 

[odieoh]

Try reading better. I'm fully behind ODs Rxing Latisse as its a drug they have been using for quite some time. My statement that you quoted as in direct response to another poster trying to justify not allowing ODs to write for it on the basis that it is a cosmetic drug in this formulation.

After looking again, I stand corrected. A thousand apologies.

 

[ksidoc]

Off topic of the pissing contest. Took MCAT this morning. PS VERY hard. VR OK, same as practice. Essays: no prob, write all the time so no block. BS: absolutely felt like I knew everything that was asked; feel like this is more dangerous than feeling like a ***** on PS. Four weeks and we will find out. Positive vibes welcome.

 

[DKofLV]

Off topic of the pissing contest. Took MCAT this morning. PS VERY hard. VR OK, same as practice. Essays: no prob, write all the time so no block. BS: absolutely felt like I knew everything that was asked; feel like this is more dangerous than feeling like a ***** on PS. Four weeks and we will find out. Positive vibes welcome.

Good luck man, we'll be pullin for ya!

 

[Meibomian SxN]

Off topic of the pissing contest. Took MCAT this morning. PS VERY hard. VR OK, same as practice. Essays: no prob, write all the time so no block. BS: absolutely felt like I knew everything that was asked; feel like this is more dangerous than feeling like a ***** on PS. Four weeks and we will find out. Positive vibes welcome.

Definitely a big good luck!

You are? Why does your title say attending?

Because I am not a resident.

 

[hello07]

Become the best opthalmic surgeon you can. Whether it is cornea, retina, muscles/pediatric & adult, glaucoma/cataract aqcuire great skills thru learning, observing and experience. You have nothing to worry about OD's no matter thru legislation how much they can or can't do. We won't be doing PRP or scleral buckle any time soon. We won't be putting IOL's in anyones eyes anytime soon either.

Know your medicine and surgey well.......................become a great clinician along w a excellent bedside manner and don't worry about OD and threat of us to you.

We are no threat to you.................................

The ones that know this OMD are cream of the crop.

GL!

 

[DOCTORSAIB]

Because I am not a resident.

Then why doesn't it say "Optometrist" if you're not a resident?

 

[DrMassacre]

^ I think it's because he doesn't know the proper meaning of an attending.

 

[Meibomian SxN]

^ I think it's because he doesn't know the proper meaning of an attending.

Then why doesn't it say "Optometrist" if you're not a resident?

Maybe because you are under the assumption that an attending has to be a medical doctor?

Merriam-Webster Definition:
: serving as a physician on the staff of a teaching hospital.

If I were at your teaching facility, I would be an attending and you...still the resident! I personally know of ODs who also are faculty and ATTENDINGS at ophthalmology teaching institutions.

So how about getting over yourselves...trust me, it makes for a MUCH better physician/surgeon! 😉






In the United States, an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency.

 

[DKofLV]

Maybe because you are under the assumption that an attending has to be a medical doctor?

Merriam-Webster Definition:
: serving as a physician on the staff of a teaching hospital.

If I were at your teaching facility, I would be an attending and you...still the resident! I personally know of ODs who also are faculty and ATTENDINGS at ophthalmology teaching institutions.

So how about getting over yourselves...trust me, it makes for a MUCH better physician/surgeon! 😉






In the United States, an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency.

with all due respect, why are you the only optometrist here that has a title listed as anything other than optometrist then?

 

[Visionary]

Maybe because you are under the assumption that an attending has to be a medical doctor?

In the United States, an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency.

Meibomian SxN-

I can't believe I'm jumping into this ridiculous thread again, but per your own Wikipedia citation: "In the United States and Canada, the term physician usually describes all those holding the degrees of Doctor of Medicine (MD) and Doctor of Osteopathic Medicine (DO). Within North America, the title physician, in this broad sense, also describes the holders of medical degrees from other countries that are equivalent to the North American Doctor of Medicine degrees; typical examples of such degrees from non-North American countries are MB BChir, BM BCh, MB BCh, MB ChB, MBBS, BM, M.B.B.S. etc.. In the US, only those graduating from faculties listed in the WHO Directory of Medical Schools [6] are able to apply for medical licensure in the relevant US jurisdiction, via the ECFMG."

With all due respect, you are an Optometrist, not a Physician. Without the appropriate credentials, you should not use the title "Attending." That is the point that is being made.

 

[DrMassacre]

In the United States, an attending physician (also known as an attending, or staff physician) is a physician who has completed residency and practices medicine in a clinic or hospital, in the specialty learned during residency.

I'm not assuming anything, nor do I lack any respect toward optometrists. I think they're doctors like myself (but not a physician). An attending or physician is someone that practices medicine, as stated in wikipedia (which is our generation's standard).

Or, if you wanted to use your merriam-weber definition of a physician: 1 : a person skilled in the art of healing; specifically : one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery

So how about getting over yourselves...trust me, it makes for a MUCH better physician/surgeon! 😉

And no offense, but how would you know? You're neither. And as a side note, I really have no problems with optometrists at all but individuals like yourself who try and make yourself into something you're not really rubs me the wrong way.

 

[Mirror Form]

Granted but after the stunt ODs pulled in Oklahoma, one can't help but question their motives.

Unfortunately, you have a point. After the Oklahoma stunt, many physicians believe that optometry did not demonstrated the ability to ethically determine what they should and should not be doing. As KHE pointed out, it's not economically viable for optometrists to be doing cataract surgery, and that is really all that is preventing OD's in Oklahoma from doing it.

Likwise, the LASIK market is already extremely competitive. Most ophthalmologists don't do much of it simply b/c it's hard to compete with all the big practices advertising discount prices on TV/radio. So how many optometrists would really benefit if their scope was expanded for refractive surgery?

While Latisse is an easy example of something that optoms should be able to use safely and ethically, optoms shouldn't get too surprised when people question their motives and ethics. Optometry's overly aggressive scope expansion efforts toward surgery has caused physicians and medstudents to view the field with suspicion.

 

[Meibomian SxN]

with all due respect, why are you the only optometrist here that has a title listed as anything other than optometrist then?

Because I was also working part time at a teaching hospital at the time I joined.

I'm not assuming anything, nor do I lack any respect toward optometrists. I think they're doctors like myself (but not a physician). An attending or physician is someone that practices medicine, as stated in wikipedia (which is our generation's standard).

Or, if you wanted to use your merriam-weber definition of a physician: 1 : a person skilled in the art of healing; specifically : one educated, clinically experienced, and licensed to practice medicine as usually distinguished from surgery......

Outside of surgery, how is an ophthalmologist's healing different than an optometrist? Medicine is not just pills & needle pricks, even though it seems that's all you godly MDs seem to retain from school. Aside from surgery, in the office you are no different than me except for who has more breadth of knowledge and artful skill.

As was stated in a previous thread, this is all about turf. I would have more respect if you would just admit that and stop pretending.

As for the title, I don't need it to define me. I'll change it to stand proud of who I am: an Optometric Physician 😉

 

[orbitsurgMD]

Because I was also working part time at a teaching hospital at the time I joined.



Outside of surgery, how is an ophthalmologist's healing different than an optometrist? Medicine is not just pills & needle pricks, even though it seems that's all you godly MDs seem to retain from school. Aside from surgery, in the office you are no different than me except for who has more breadth of knowledge and artful skill.

As was stated in a previous thread, this is all about turf. I would have more respect if you would just admit that and stop pretending.

As for the title, I don't need it to define me. I'll change it to stand proud of who I am: an Optometric Physician 😉

Then by the same reasoning, a dentist is a "dental physician", a veterinarian a "veterinary physician" and a physical therapist is a "physical therapy physician?"

Optometry appropriated, or rather arrogated the title "physician," by fiat, no one outside that field gave the members of that profession the title of physician. They decided to call themselves "physicians" in a very obvious strategy to expand the scope of their practice by appropriation of titles used by medical practitioners. The effort is one that intentionally blurs the distinction between the profession of medicine, which has distinct (and also more rigorous) requirements with that of optometry which while unique, does not have as rigorous a set of requirements for qualification. And, unfortunately by the same self-defining methods, they are also now calling themselves "surgeons." By the same logic, anyone could call themselves a Professor if they wanted to, without any kind of appointment.

The entire effort suggests a notion of perceived inferiority, as if calling oneself "Optometrist" was something less than "Optometric Physician."

 

[KHE]

Unfortunately, you have a point. After the Oklahoma stunt, many physicians believe that optometry did not demonstrated the ability to ethically determine what they should and should not be doing. As KHE pointed out, it's not economically viable for optometrists to be doing cataract surgery, and that is really all that is preventing OD's in Oklahoma from doing it.

Do you honestly believe that? Do you honestly think that if Medicare magically started reimbursing $5000 for cataract extraction that a slew of Okie ODs are going to start cutting and sewing tomorrow? That's crazy.

Likwise, the LASIK market is already extremely competitive. Most ophthalmologists don't do much of it simply b/c it's hard to compete with all the big practices advertising discount prices on TV/radio. So how many optometrists would really benefit if their scope was expanded for refractive surgery?

Yet all we hear is how optometrists just want to do laser surgery.

While Latisse is an easy example of something that optoms should be able to use safely and ethically, optoms shouldn't get too surprised when people question their motives and ethics. Optometry's overly aggressive scope expansion efforts toward surgery has caused physicians and medstudents to view the field with suspicion.

I don't know how many more times I can explain this.

YES, it's about money, but no it's NOT about surgery. It's about who will ultimately decide optometric scope of practice. Optometrists and optometry boards, or "someone else?" It's about being able to do the things that we are in fact trained to do.

It's about not having to and grovel when Latisse comes out. It's about not having to go and grovel everytime a new contact lens comes out.

It's about not having to go through the charade of having some ophthalmologist at a public health hearing waving around a bottle of tropicamide ominously declaring that "you can kill someone with this drug."

You say "Oh yea well the Latisse thing is an easy example of something they should do" yet why was it an issue? If it's such an "easy" thing, then it should have been a rubber stamp, no?

Orbitsburg makes reference in another posting to the whole optometric physician thing. How many more times can I explain that one? Yes, there are a handful of optometrists who love to pretend that they're physicians and proudly display the term "optometric physician" on their business card but the reality of it is is that 99.5% of ODs DO NOT GIVE A CRAP about that. The term "physician" appears no where in my office, on my literature, on my stationary or in the office of any OD that I know or have ever known.

So WHY pray tell, do some ODs use that term?

For the 100th time, because 20 years ago, Medicare and most other major medical plans would only allow "physicians" to participate. So rather than ophthalmology going to the various medical directors of the various plans and saying "hey, let these guys participate because they're qualified to do it and we don't want our offices filled with contact lens seasonal allergy patients and routine pink eye cases" they chose instead to put up roadblocks.

Ok, so then unfortunately we're left with no other option but to lobby the legislatures to declare us physicians so *poof* now we're physicians and we can take Blue Cross and prescribe patanol. Yay. Party time!

As far as surgery goes, it's the same old song and dance. ODs don't want to do cataracts and LASIK. We want to be able to remove superficial foreign bodies and epilate some lashes and plug up a couple of puncta on our contact lens/dry eye patients. Technically those are surgical procedures.

So rather than saying "yea, these guys can do these things, let's let them" it was road block after road block after road block.

So what are we supposed to do? Our only choice is to lobby the legislatures to say that "YES! ODs can do surgery!" And now we do surgery. We're just epilating all over the place. Have tweezers, will travel.

So I "get" why you think the motives of ODs are all nefarious and such but cmon.....

Now someone, Dr. Doan probably is going to post some 10 year old article from some OD like Chris Quinn or some Okie OD who honestly does think that ODs should do LASIK. I'm not denying that there's about 5 of them out there but seriously.....have any of you actually BEEN in optometrists office? Does it look like we're just dying to do cataract extractions here?

 

[Meibomian SxN]

Then by the same reasoning, a dentist is a "dental physician", a veterinarian a "veterinary physician" and a physical therapist is a "physical therapy physician?"

Optometry appropriated, or rather arrogated the title "physician," by fiat, no one outside that field gave the members of that profession the title of physician. They decided to call themselves "physicians" in a very obvious strategy to expand the scope of their practice by appropriation of titles used by medical practitioners. The effort is one that intentionally blurs the distinction between the profession of medicine, which has distinct (and also more rigorous) requirements with that of optometry which while unique, does not have as rigorous a set of requirements for qualification. And, unfortunately by the same self-defining methods, they are also now calling themselves "surgeons." By the same logic, anyone could call themselves a Professor if they wanted to, without any kind of appointment.

The entire effort suggests a notion of perceived inferiority, as if calling oneself "Optometrist" was something less than "Optometric Physician."

MDs fought to have the term 'residency' be made exclusive only for a select few professions, Optometry was not one of them...

So yes, we did give ourselves this 'earned' title. My patients call me doctor and trust me with their most precious of sensory organs. I chose to add the 'physician' title because of some unprofessional slandering done by your fellow ophthalmologists and some PCPs in the community. And to also separate my service of care from some other optometrists who do not empasize medical care.

All my patients have their BP checked at every visit, per my instructions. Before and on every b-blocker f/u I personally check my Px's pulse. All my diabetic Px's have their HbA1Cs memorized, per my instructions. I write scripts for blood work ranging from thyroid workups to HIV testing. I even personally show my patients how to handle & shake their suspension topicals! I'm also updated certified by the American Heart Assoc in CPR & AED training and have used this training in the office and outside during several episodes of patients needing medical attention on flights!

I doubt if you can find even FEW ophthalmologists that can match my care, which I believe should be standard. I take pride in my service, so yes some of us call ourselves optometric physicians. Because we EARNED it. !

 

[DrMassacre]

I doubt if you can find even FEW ophthalmologists that can match my care, which I believe should be standard. I take pride in my service, so yes some of us call ourselves optometric physicians. Because we EARNED it. !

Ophthalmologists CAN match your care but most choose NOT to. Why? Because if they wanted to do what you do, they would have gone into primary care. In addition, most patients already have a PCP to do all that 'medical' stuff you do. That's why ophthalmologists don't 'match' your care. Finally, a nurse practitioner does all that you mentioned plus much more but we don't go around calling them physicians now do we?

 

[Eyefixer]

Someone. Close. This. Thread. Please.

 

[Meibomian SxN]

Ophthalmologists CAN match your care but most choose NOT to. Why? Because if they wanted to do what you do, they would have gone into primary care. In addition, most patients already have a PCP to do all that 'medical' stuff you do. That's why ophthalmologists don't 'match' your care. Finally, a nurse practitioner does all that you mentioned plus much more but we don't go around calling them physicians now do we?

Do not worry, its 'physicians' like yourself that make it easy for me to stay booked up because Px's are getting tired of the allopathic medical approach. Your days are numbered...

Actually we will start calling the nurse practitioners the new PCPs soon because their's a shortage of good PCPs and the practioners have shown that their services are more care oriented than many PCPs out there. Stay tuned...

 

[Mirror Form]

Do you honestly believe that? Do you honestly think that if Medicare magically started reimbursing $5000 for cataract extraction that a slew of Okie ODs are going to start cutting and sewing tomorrow? That's crazy.

It would turn into a massive lobbying battle if they did, but I wouldn't be surprised if a few attempted to do it. You say they don't represent the majority and I agree. However, they are well tolerated by the majority of optometrists.

Yet all we hear is how optometrists just want to do laser surgery.

I know, that is because a lot of optometrists used to want to do lasik. Can you honestly tell me that five years ago you did not know any of your colleagues that wanted to perform lasik in the future? I used to know at least a few of them. As the market has become saturated and then crashed, I think most optometrists have realized it's not easy money.

I don't know how many more times I can explain this.

YES, it's about money, but no it's NOT about surgery. It's about who will ultimately decide optometric scope of practice. Optometrists and optometry boards, or "someone else?" It's about being able to do the things that we are in fact trained to do.

It's about not having to and grovel when Latisse comes out. It's about not having to go and grovel everytime a new contact lens comes out.

It's about not having to go through the charade of having some ophthalmologist at a public health hearing waving around a bottle of tropicamide ominously declaring that "you can kill someone with this drug."

You say "Oh yea well the Latisse thing is an easy example of something they should do" yet why was it an issue? If it's such an "easy" thing, then it should have been a rubber stamp, no?

I understand and agree with you. Both optometry and ophthalmology will fight for their turf. The difference is that recently optometrists in Oklahoma greatly over-stepped what is defensible.

And then that raises the question, who should decide the scope of highly trained mid-level providers? Should podiatrists be the sole source on deciding their scope? Should nurse practicioners be the sole source on deciding their scope? What about CRNA's and PA's? Obviously all of those providers will be biased. Likewise, so will the physicians they compete with.

I don't think giving the mid-level providers free reign to do whatever they feel they should be able to do is the answer.

 

[Meibomian SxN]

...And then that raises the question, who should decide the scope of highly trained mid-level providers? Should podiatrists be the sole source on deciding their scope? Should nurse practicioners be the sole source on deciding their scope? What about CRNA's and PA's? Obviously all of those providers will be biased. Likewise, so will the physicians they compete with.

I don't think giving the mid-level providers free reign to do whatever they feel they should be able to do is the answer.

Obviously it should not be an MD because there is a big conflict of interest there. The professions collectively decide and provide rationale, proof of training, competence etc.

Podiatrists all have differing scopes in different states. Some states they are limited to the foot, others can do up to the knee, some states they can do some hand surgeries. They have proven their competent and showed they are trained to handle such.

Outside of that, its just plain as day TURF WAR. 😡

 

[KHE]

Obviously it should not be an MD because there is a big conflict of interest there. The professions collectively decide and provide rationale, proof of training, competence etc.

Podiatrists all have differing scopes in different states. Some states they are limited to the foot, others can do up to the knee, some states they can do some hand surgeries. They have proven their competent and showed they are trained to handle such.

Outside of that, its just plain as day TURF WAR. 😡

Huh? In what universe are podiatrists doing HAND surgery? That's news to me. 😕

I can't fathom seeing a podiatrist if I needed surgery on my hand.

 

[Meibomian SxN]

Huh? In what universe are podiatrists doing HAND surgery? That's news to me. 😕

I can't fathom seeing a podiatrist if I needed surgery on my hand.

I'm not a podiatrist but as far as I know (in the states that permit it) they can perform minor surgery on the hands. Most likely removing warts etc.

But by having laws on the books, it allows for more expansion when needed. Qudos for them.

 

[MR1]

Agree, pods doing hands doesn't make any sense, they are foot surgeons. It would be like me the eye surgeon doing a kid's strab surgery and ear tubes at the same time.

Yes it is a turf war but the problem with saying that all OD's should decide their scope, or NP's, pods, etc is what is to stop them from saying they can do everything.

 

[Meibomian SxN]

Agree, pods doing hands doesn't make any sense, they are foot surgeons. It would be like me the eye surgeon doing a kid's strab surgery and ear tubes at the same time.

Yes it is a turf war but the problem with saying that all OD's should decide their scope, or NP's, pods, etc is what is to stop them from saying they can do everything.

Its something to do with the name. As a medical student I am sure you remember that the hands and feet are very similar in nature.

As far as surgery I believe (do not quote me) they can remove warts and such, not hand transplants etc. But the fact that they can perform a procedure on that area and bill for it is the case in point.

You have reckless doctors in every field of medicine, but they make up the minority. Most doctors know their limitations and typically stop there. If someone can prove proficiency in a technique, I do not see what the problem is...aside from it being turf war.

 

[Oculomotor]

The reality is whenever the examples of podiatrists and dentists doing all sorts of surgical procedures (and NO they have no Medical School training) is brought up in an argument to show that you could have a 4 yr residency after an OD program to produce an eye surgeon, the OMD, MD, or whoever you are talking to never wants to acknowledge it. They just change the subject because that reality is telling. OMD's are just protecting their profession and don't want to admit that OMFS's and DPM's safely performing surgery for years with no real medical school training in their respective dental and podiatric schools. Both of these surgeons go to a 3-4 yr residency program after dental and podiatry school.
One example of a 4-yr oral surgery residency with the requirement for the program being a DDS/DMD degree NOT an MD.

http://www.whcenter.org/body.cfm?id=639 (80% of OMFS docs have the 4 yr residency and no MD)

Dental students are not trained "systemically" in the same sense as medical students---not even close rather they are trained in a focused area of dental medicine with systemic relationships just like optometry and podiatry...... I took most of my hardest basic science courses along side with the dental students.....

Dental, optometric, and podiatry doctoral programs are NOT equivalent to medical school they are just different. If I was an OMD I probably would be just as protective and hostile about the idea of an optometric surgery residency but I am not lol...so I support the other side. It is what it is.
Recently I had a very interesting conversation with a general ophthalmologist about this very subject. This OMD was an attending at a rotation I was on and basically layed it out very simply, "Ophthalmologists deep down , many of them, not all, feel that they had to go through a longer and tougher road to get to where they are. Most of them aren't even aware of your training or really even care about it. Even though Oral Surgeons went to dental school and most did only a 4 yr residency following that, they do not directly compete with any medical field most of the time. Generally, I just think that we are just protecting our turf whether or not another "pathway" could be established. There really is no need for it as the way things are now with OD's doing most of the primary care and us doing surgery and complex care works well." This is not word for word but almost exactly what she said! I would just like someone on SDN's Ophthalmology forum here to be honest and just say that they feel deep down that as an OMD they are superior to OD's and they don't want them cherry picking surgery from them.......I for one am really tired of all of this maneuvering, "patient safety" scare tactics, and hubris. I know that is how some of these OMD's feel ---> I have overheard them talk and I have been told to my face by one older OMD that we should be basically refracting and that is it! This is after I told him that OD's can prescribe oral medicines in 47 states...He flipped out! LOL And yes, I interact with a lot of OMD's and most of them are great.
Optometry is at fault here too in regard to their perception in the ophthalmology community with some of the OD's I know sending out simple things rather than treating them to reap more profits from the optical. I know 2 optometrists in the area that really treat nothing medical and send out basically every "red eye" they see. In the process they are making all of us look bad because the majority of OD's I know practice some form of medical optometry. The further I get into this profession of optometry (ultimately being the primary eye doctor) I realize that this nonsense between OMD's and OD's will NEVER end. I am actually really sick of it. And although I don't agree with 90% of what KHE says I do agree with him on the concept that most OD's want nothing to do with surgery--that is very true because the economic reward is just not there when you have a group of established ophthalmic surgeons. Most of the OD's just want to be able to practice at the level they were taught. In my case that would include periocular injections. I am just going to "take the good/ leave the bad" and practice medical optometry at the highest level that I can ( 4 year OD degree, 1 year residency, board certification (ABO--new entity 2009), glaucoma fellowship (new entity--2009). I will learn everything I can from the OMD's I encounter so I thank them wholeheartedly in advance. 👍

The US got jobbed in the World Cup game against Slovenia!!!!!! 👎

 

[FutureCTDoc]

DPMs and DMDs are invalid comparisons. Look at the structure of dental/podiatry school, 2 years basic science, 2 years clinic for dentists or clerkships for pods plus optional (although not in all states) residencies for dentists and 3 years for pods. OMFS 50% of them are MDs. The other 50% have 4 years of post-graduate training. ODs do not have this sort of training. Also the foot and mouth are less delicate and complex than the eye. If you want to perform ophthalmology go to medical school. You know going in the scope of optometry, if you don't like it don't go into it. It isn't that a cataract is an obscenely difficult procedure. It's that things can go horribly wrong. Can you handle losing vitreous? What about a lens in the back of the eye? Endophthalmitis?

 

[MR1]

Of course it only is a matter of protecting our turf. As many have said there is NO need for a different pathway. So of course we want to protect what is ours.

As far as patient safety, this does play a role though. Anecdotal evidence isn't worth anything but in my experience I know of 1-2 good medical OD's, the rest worry me a lot with the diagnosises they give on referrals.

So I will agree the dial spinning only OD's do taint your profession from being more well respected but it is the reality, the folks on here that post a lot that are OD's seem to really know there stuff and are probably excellent OD's but they are the exception.

I always use the phrase you shouldn't do ANYTHING if you can't handle the complication that might arise. Now granted if you drop a lens as a cataract cowboy you aren't going to bust out the vitrectomy and get it but you technically know how because you saw them in residency and maybe even did them. Same for periocular injections, I am assuming you mean things like subtenon kenalog, well those can give serious glaucoma issues, they aren't benign, technically you could even perf a globe.

 

[hello07]

Oculomotor, I understand your statement from head to toe. In your case, how many periocular injections have you performed in optometry school on pts? I bet zero. You might see, learn them from OMDs but how many are you actually going to do on pts in clinical practice if need be? None. Many OMDs don't perform them and give them to those who do althought they are all taught on how to do them.

Synopsis: you might have missed your calling. MCAT's--apply---get in---rock----pt 1 pt 2----interview----get into ophth residency------do all what your heart desires. The process is still there for you.


board certification for OD's is ridiculous but necessary for billing and panels= that's all. Glaucoma fellowship? Good Luck. You'll be treating pts and competing w/ glaucoma specialts OMD who can do everything under the sun.

Your delusional................

 

[DKofLV]

Oculomotor, I understand your statement from head to toe. In your case, how many periocular injections have you performed in optometry school on pts? I bet zero. You might see, learn them from OMDs but how many are you actually going to do on pts in clinical practice if need be? None. Many OMDs don't perform them and give them to those who do althought they are all taught on how to do them.

Synopsis: you might have missed your calling. MCAT's--apply---get in---rock----pt 1 pt 2----interview----get into ophth residency------do all what your heart desires. The process is still there for you.


board certification for OD's is ridiculous but necessary for billing and panels= that's all. Glaucoma fellowship? Good Luck. You'll be treating pts and competing w/ glaucoma specialts OMD who can do everything under the sun.

Your delusional................

well said! besides, it was so much nicer/more pleasant in our forums til the troll (oculomotor) came back

 

[bungo]

The reality is whenever the examples of podiatrists and dentists doing all sorts of surgical procedures (and NO they have no Medical School training) is brought up in an argument to show that you could have a 4 yr residency after an OD program to produce an eye surgeon, the OMD, MD, or whoever you are talking to never wants to acknowledge it. They just change the subject because that reality is telling. OMD's are just protecting their profession and don't want to admit that OMFS's and DPM's safely performing surgery for years with no real medical school training in their respective dental and podiatric schools. Both of these surgeons go to a 3-4 yr residency program after dental and podiatry school.
One example of a 4-yr oral surgery residency with the requirement for the program being a DDS/DMD degree NOT an MD.

http://www.whcenter.org/body.cfm?id=639 (80% of OMFS docs have the 4 yr residency and no MD)

Dental students are not trained "systemically" in the same sense as medical students---not even close rather they are trained in a focused area of dental medicine with systemic relationships just like optometry and podiatry...... I took most of my hardest basic science courses along side with the dental students.....

Dental, optometric, and podiatry doctoral programs are NOT equivalent to medical school they are just different. If I was an OMD I probably would be just as protective and hostile about the idea of an optometric surgery residency but I am not lol...so I support the other side. It is what it is.
Recently I had a very interesting conversation with a general ophthalmologist about this very subject. This OMD was an attending at a rotation I was on and basically layed it out very simply, "Ophthalmologists deep down , many of them, not all, feel that they had to go through a longer and tougher road to get to where they are. Most of them aren't even aware of your training or really even care about it. Even though Oral Surgeons went to dental school and most did only a 4 yr residency following that, they do not directly compete with any medical field most of the time. Generally, I just think that we are just protecting our turf whether or not another "pathway" could be established. There really is no need for it as the way things are now with OD's doing most of the primary care and us doing surgery and complex care works well." This is not word for word but almost exactly what she said! I would just like someone on SDN's Ophthalmology forum here to be honest and just say that they feel deep down that as an OMD they are superior to OD's and they don't want them cherry picking surgery from them.......I for one am really tired of all of this maneuvering, "patient safety" scare tactics, and hubris. I know that is how some of these OMD's feel ---> I have overheard them talk and I have been told to my face by one older OMD that we should be basically refracting and that is it! This is after I told him that OD's can prescribe oral medicines in 47 states...He flipped out! LOL And yes, I interact with a lot of OMD's and most of them are great.
Optometry is at fault here too in regard to their perception in the ophthalmology community with some of the OD's I know sending out simple things rather than treating them to reap more profits from the optical. I know 2 optometrists in the area that really treat nothing medical and send out basically every "red eye" they see. In the process they are making all of us look bad because the majority of OD's I know practice some form of medical optometry. The further I get into this profession of optometry (ultimately being the primary eye doctor) I realize that this nonsense between OMD's and OD's will NEVER end. I am actually really sick of it. And although I don't agree with 90% of what KHE says I do agree with him on the concept that most OD's want nothing to do with surgery--that is very true because the economic reward is just not there when you have a group of established ophthalmic surgeons. Most of the OD's just want to be able to practice at the level they were taught. In my case that would include periocular injections. I am just going to "take the good/ leave the bad" and practice medical optometry at the highest level that I can ( 4 year OD degree, 1 year residency, board certification (ABO--new entity 2009), glaucoma fellowship (new entity--2009). I will learn everything I can from the OMD's I encounter so I thank them wholeheartedly in advance. 👍

The US got jobbed in the World Cup game against Slovenia!!!!!! 👎

Do you break out the word processor each time you compose these essays? Not sure who will be sending you those patients for ocular injections.

I don't think anyone looking towards the future should be trying to become the second best guy to provide a certain service. You will be at a huge disadvantage, and possibly unemployable.

 

[speyeder]

The reality is whenever the examples of podiatrists and dentists doing all sorts of surgical procedures (and NO they have no Medical School training) is brought up in an argument to show that you could have a 4 yr residency after an OD program to produce an eye surgeon, the OMD, MD, or whoever you are talking to never wants to acknowledge it. They just change the subject because that reality is telling. OMD's are just protecting their profession and don't want to admit that OMFS's and DPM's safely performing surgery for years with no real medical school training in their respective dental and podiatric schools. Both of these surgeons go to a 3-4 yr residency program after dental and podiatry school.
One example of a 4-yr oral surgery residency with the requirement for the program being a DDS/DMD degree NOT an MD.

http://www.whcenter.org/body.cfm?id=639 (80% of OMFS docs have the 4 yr residency and no MD)

Dental students are not trained "systemically" in the same sense as medical students---not even close rather they are trained in a focused area of dental medicine with systemic relationships just like optometry and podiatry...... I took most of my hardest basic science courses along side with the dental students.....

Dental, optometric, and podiatry doctoral programs are NOT equivalent to medical school they are just different. If I was an OMD I probably would be just as protective and hostile about the idea of an optometric surgery residency but I am not lol...so I support the other side. It is what it is.
Recently I had a very interesting conversation with a general ophthalmologist about this very subject. This OMD was an attending at a rotation I was on and basically layed it out very simply, "Ophthalmologists deep down , many of them, not all, feel that they had to go through a longer and tougher road to get to where they are. Most of them aren't even aware of your training or really even care about it. Even though Oral Surgeons went to dental school and most did only a 4 yr residency following that, they do not directly compete with any medical field most of the time. Generally, I just think that we are just protecting our turf whether or not another "pathway" could be established. There really is no need for it as the way things are now with OD's doing most of the primary care and us doing surgery and complex care works well." This is not word for word but almost exactly what she said! I would just like someone on SDN's Ophthalmology forum here to be honest and just say that they feel deep down that as an OMD they are superior to OD's and they don't want them cherry picking surgery from them.......I for one am really tired of all of this maneuvering, "patient safety" scare tactics, and hubris. I know that is how some of these OMD's feel ---> I have overheard them talk and I have been told to my face by one older OMD that we should be basically refracting and that is it! This is after I told him that OD's can prescribe oral medicines in 47 states...He flipped out! LOL And yes, I interact with a lot of OMD's and most of them are great.
Optometry is at fault here too in regard to their perception in the ophthalmology community with some of the OD's I know sending out simple things rather than treating them to reap more profits from the optical. I know 2 optometrists in the area that really treat nothing medical and send out basically every "red eye" they see. In the process they are making all of us look bad because the majority of OD's I know practice some form of medical optometry. The further I get into this profession of optometry (ultimately being the primary eye doctor) I realize that this nonsense between OMD's and OD's will NEVER end. I am actually really sick of it. And although I don't agree with 90% of what KHE says I do agree with him on the concept that most OD's want nothing to do with surgery--that is very true because the economic reward is just not there when you have a group of established ophthalmic surgeons. Most of the OD's just want to be able to practice at the level they were taught. In my case that would include periocular injections. I am just going to "take the good/ leave the bad" and practice medical optometry at the highest level that I can ( 4 year OD degree, 1 year residency, board certification (ABO--new entity 2009), glaucoma fellowship (new entity--2009). I will learn everything I can from the OMD's I encounter so I thank them wholeheartedly in advance. 👍

The US got jobbed in the World Cup game against Slovenia!!!!!! 👎

Glaucoma fellowship? What services are you going to offer a patient that they can't get from a glaucoma specialist? What are you going to do if a patient is on maximum medical therapy and progressively loses vision? Offer them surgery? Of course not, cause you're not an eye surgeon. So basically you're going to follow them and treat them medically and refer them when they need surgery right? Well, we already have people who do this, and they're called ophthalmologists.

 

[MR1]

Agree, I am actually curious what tricks you think a glaucoma fellowship would give an OD to put in his pocket.