Reality check for those interested in ophtho

[Andrew_Doan]

Dr. Doan,

Do you believe that central cecal defects will be the first field defect seen in a NTG patient?
Regards,
Richard_Hom

The current thought is that NTG patients with paracentral defects are symptomatic first; thus, there may be a selection bias.

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[GeddyLee]

Dr. Doan,

Do you believe that central cecal defects will be the first field defect seen in a NTG patient?
Regards,
Richard_Hom

You'd have to be one heck of an extraordinary ophthalmologist or optometrist to notice defects in a patient's cecum through the eye exam.

 

[Andrew_Doan]

It's a typo, he meant ceco-central scotoma. But these are classically chiasmal lesions.

NTG usually manifest as para-central scotomas.

 

[GeddyLee]

hehe...i was just kiddin

 

[ODhopeful]

FYI, I do care about the future of ophthalmology. I don't care about making millions. I plan to be an academic. I will be working for the US military. Thus, my fundamental political interests are based on my concern for patients and maintaining high standards for my field.

Dr. Doan,
I admire your noble intentions and being a future OD I wish that people in our fields respectively would not put money in front of everything that exists. Gotta give you two thumbs up

 

[HOLLYWOOD]

I am interested in ophtho. However, there are things that bother me and I am not sure what you guys think about these. I think many bright students consider this rout without considering what happens when they get out of residency. I will include the following excerpt from an ophtho department student advisor:
CURRENT TRENDS:
Like many other surgical specialties, there is an over supply of ophthalmologist nationally, particularly in >desirable= urban areas. Also like other surgical specialties, there is a trend towards lower reimbursement for ophthalmic surgery. Starting salaries for ophthalmologists continue to drop, especially in urban areas most heavily impacted by managed care. Optometrists ? are using the political process to attain the right to treat disease in many states. Currently in most states, optometrists are limited to treating allergic eye disease and mild infections. This will undoubtedly change over the coming years, and it is clear that the ultimate goal of organized optometry is to gain complete parity with ophthalmology in the management of both medical and surgical disease. In Oklahoma, a recent law was passed that allows optometrists full surgical laser privileges. It is likely that similar laws will eventually pass throughout the country, so that there will be an even larger over-supply of eye care providers.
Sorry for the long post. However, from what I hear:
1. There is certainly an over supply of ophthalmologists. OK, I realize that aging population will likely increase demand. However to what extent?
2. The optometrists gaining surgical rights is a REAL THREAT to this wonderful field unfortunately! Read the following from the AAO website and you will realize (http://www.aao.org/aao/news/washington/013003_article3.cfm). I do not see a reason why they would not be able to perform simple surgical procedures such as refractive surgery or laser ablation procedures, especially in the current managed care system seeking low costs.
3. Ophthalmologists currently make about $120-130 K starting salary. That is the same as internal med docs. It is the lowest of any surgical subspecialty I have heard of.
4. It is ridiculously hard to match in ophtho. That means it?s harder to go to a program that would set you up with a job or fellowship after you get out. I could pick and choose where I want to go to do a residency in something like medicine or maybe even ED, but I am not sure if I can get into ophtho (based on previous posts from actual applicants).
5. It is not that easy for all residents and fellows to find jobs, especially if they want to stick around popular locations such as in California.
Do I really want to still put in 5 years of my life and work hard on research projects etc for this field with some questions about its future? I am debating that.
I personally think that there are a lot of people who still think ophtho is the field it used to be back in the 80?s. I would really appreciate input especially from the doctors in the forum.
Thanks,
hbs

If you want to be an OMD, go for it don't worry about OD's. If your a good surgeon and a good business man you should do fine. As far as reimbursments are concerned that is something everybody has to fight. On this forum they always talk about OD's doing surgery, what they should worry about is getting paid for your services.

 

[HOLLYWOOD]

My biggest concern with the field is also the ?optometrists taking over? factor. Read the two threads posted by Dr. Doan above and pay attention to the sentiment of the optometrists who post on these threads. I do not know what optometrist learn for 3-4 years, but I can see them being able to learn to handle all major eye problems in this period of time! I just think that it is a matter of who has more lobbying power at this point. OD?s out number Ophthalmologists. I do think that it would be unfair to ophthalmologists to lose surgical rights. It has not happened yet, but it is possible.
hbs

Ophthalmologists are not going to lose surgical rights, they may not get paid for surgery. Reimbursment for cataract surgery is about $650. Jonh S. a hair dresser to the stars charges $400 for a wash and cut.

 

[HOLLYWOOD]

Lets face it, the average OD student (no all, just the average) probably could not get into medical school, whereas you have to be a top medical student to become an ophthalmologist. Does it make any sense at all then if the two groups could do the exact the same thing? In addition, you have 4 years of instruction vs. eight years. How could there possibly not be any difference in patient outcomes in regards to surgical procedures by the two groups? I'm not well informed about laser surgery, but my understanding is that calibrating the machine to the patient is the most important part, and perhaps surgical training isnt important. What I wonder though is whether or not ODs would be able to handle more invasive surgical procedures without a surgical background.

On the other hand, podiatrists and orthopods seem to co-exist perfectly fine. Could basic laser procedures be relegated to the world of the OD whereas Ophthos are pushed towards more invasive procedures? The way it looks now it seems like ophtho's will have to do a fellowship to ensure job security in the future. Is this just all a bunch of hand waving or is there something going on.

You have three years of ophthalmology instruction.

 

[HOLLYWOOD]

HBS try to do a phaco and tell me how easy it will be for optoms to take over. It's a very difficult procedure, very unforgiving, and just b/c someone who has practiced for 10 years makes it look easy it's not. Your three years in ophtho is not time spent sitting around, you need that time to learn how to diagnose cases needing treatment and implementing treatment. I think if Optoms did and internship then residency it could be conceivable they gain rights to do what we do. But enough of that debate, that's not what is at issue here. I think you need to spend some time rotating with and optom and ophthalmologist if you are considering the field. I think someone at your level has no way of knowing the difference b/t the two and what is involved in day to day practice. Remember, while lasers can be simple, they can also blind. I've heard of patients with their foveas prp and poor vision b/c the looked at the red laser beam. Also, yags may seem simple until you have the patient return with and rd, or endophthalmitis b/c you released the p acnes hiding back there in the cortical remnants, or the pt has a pressure spike and goes blind.

The people steeling your livelyhood are the insurance companies,not the od's.

 

[HOLLYWOOD]

I completely agree with ckyuen. Retinal detachments can occur in 1-2% of patients after Yag cap. It's not a trivial procedure. If you do enough procedures, then there will be complications.

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=14967269

The training of ophthalmologists and optometrists are completely different. ODs will argue that their education is similar, but they don't see enough pathology. Most will see normal individual after normal individual during their clinicals. I think most optometry students see less than a few hundred patients during their clinicals by themselves (I'm not counting "shadowing"). Less than 10% of optometrists pursue a one year residency training program.

In contrast, ophthalmology residents will see over 8,000-10,000 patients during their training with the majority having serious pathology. Mix this in with over 300-500 surgeries as the primary surgeon (Class 1), 500+ surgeries as the assistant (Class 3), and 100-200+ laser procedures, then you will have the ophthalmologist gaining vast amounts of clinical, medical, and surgical experience during residency. This is more experience and training than all optometrists, new grads and those in practice.

I agree od's don't see enough pathology. But when an od and a gen. omd see a rd how is the general ophth. going to tx it ? and the od?

 

[HOLLYWOOD]

I also think the general public does not appreciate the differences between an OD and an OMD. I myself as a premed did not know the different until my first year of college, so I could completely see how most people would think they both went to med school.

Maybe if people called them "optometrists" and "eye surgeons" the distinction might be clearer?

In any case, these politicians are pandering to their constituencies, so unless the general public understands the difference in training and quality of care, OD representatives are likely to have their way in invading OMD procedures.

perfect go see a surgeon when you need surgery and an optometrist when you need glasses, contacts or routine care.

 

[HOLLYWOOD]

I

Exactly, and now that Oklahoma has established a precedent, it will be MUCH HARDER for opthos to argue against similar privileges being doled out in other states.

I'm sure ODs in OK are busy right now compiling data about how their PRK procedures are no worse than those being done by opthos. I hope the opthos have competing data arguing against that, because if they dont, opthos are going to lose the battle.

Opthos spend way too much time making irrelevant arguments about how ODs are not "trained" to deal with PRK, instead of actually fighting the most important aspect of this which is clinical outcomes data.

Do you have data showing PRK performed by ODs to be worse than MDs?

I hate it when I go to the dr. and I see the PA and then the PA writes a prescription. I wish you guys would fight that also. they have four years of schooling. Thats almost as bad as od's with 8 years of school.HEY what do you think of the guy that gets in to medical school early( after 3 yrs. of college) then does medical school and a one yr. internship, and get a license to practce general medicine that sounds very safe. AND dont say that it doesn't happen b/c it does.

 

[rubensan]

I
I hate it when I go to the dr. and I see the PA and then the PA writes a prescription. I wish you guys would fight that also. they have four years of schooling. Thats almost as bad as od's with 8 years of school.HEY what do you think of the guy that gets in to medical school early( after 3 yrs. of college) then does medical school and a one yr. internship, and get a license to practce general medicine that sounds very safe. AND dont say that it doesn't happen b/c it does.

fight what? the fact that ODs can write prescriptions within a limited formulary? i think some of the ODs on this forum will tell you that this has been fought very hard in some states (esp NY). if this is what you are suggesting that we spend more of our energies fighting, I vote that there are bigger issues to resolve, many of which you mentioned (reimbursement from insurance and medicare [my dad informed me that we are looking at a 5% decrease in compensation every year ], surgical scope of practice , etc). I have come to believe that trying to say that MDs have a superior education and then claiming that the training of our OD, NP and PA colleagues is deficient and unworthy of limited prescription writing privileges gets us absolutely nowhere. Since you appear to be "thread surfing," just look at the unfortunately named thread "ODs are a joke not a threat" for specific examples or circular arguments (including my own) based upon this issue.

 

[HOLLYWOOD]

Yes, Florida and North Carolina are the two HARDEST states to become a practicing OD in because they have the widest scope of practice.

They do NOT accept the national part III exam because they pimp you with their own state given practical, oral qualifiying exam, and written law exams. ODs in Florida and NC are put through the RINGER to get licensed.

so, before y'all go and start claiming the sky is falling and the world is coming to an end and OH MY GOD OD's are SOOOO stupid...

Get your facts straight!!

florida does not have the broadest scope of practice'they just dont want people retiring there

 

[HOLLYWOOD]

fight what? the fact that ODs can write prescriptions within a limited formulary? i think some of the ODs on this forum will tell you that this has been fought very hard in some states (esp NY). if this is what you are suggesting that we spend more of our energies fighting, I vote that there are bigger issues to resolve, many of which you mentioned (reimbursement from insurance and medicare [my dad informed me that we are looking at a 5% decrease in compensation every year ], surgical scope of practice , etc). I have come to believe that trying to say that MDs have a superior education and then claiming that the training of our OD, NP and PA colleagues is deficient and unworthy of limited prescription writing privileges gets us absolutely nowhere. Since you appear to be "thread surfing," just look at the unfortunately named thread "ODs are a joke not a threat" for specific examples or circular arguments (including my own) based upon this issue.

I had a pt. who is a cl wearer, go to her gp for a red eye , he gave her gentamycin. the pt. had herpes. if I had done that all the omd's would be screeming,see od's s*ck,but since it was an md we don't here anything.

 

[Andrew_Doan]

I had a pt. who is a cl wearer, go to her gp for a red eye , he gave her gentamycin. the pt. had herpes. if I had done that all the omd's would be screeming,see od's s*ck,but since it was an md we don't here anything.

I agree. Non-ophthalmologists and non-optometrists have no business around the eye unless they receive more training.

 

[smiegal]

I
I hate it when I go to the dr. and I see the PA and then the PA writes a prescription. I wish you guys would fight that also. they have four years of schooling. Thats almost as bad as od's with 8 years of school.HEY what do you think of the guy that gets in to medical school early( after 3 yrs. of college) then does medical school and a one yr. internship, and get a license to practce general medicine that sounds very safe. AND dont say that it doesn't happen b/c it does.

Your PA info is not quite accurate. If you count OD's as having 8 yrs of education (including undergrad), you have to count PA's as having 7 yrs (4 undergrad + 3 Physician Assistant training). They practice under the supervision of an MD/OD, too, which is not analogous to OD autonomy. Fewer than 1% of MDs practice with only an internship (4 yrs + 4 yrs + 1 yr), and almost all of them are in very rural areas. I agree that 1 yr of post-MD training is insufficient in most clinical situations.

 

[rubensan]

I had a pt. who is a cl wearer, go to her gp for a red eye , he gave her gentamycin. the pt. had herpes. if I had done that all the omd's would be screeming,see od's s*ck,but since it was an md we don't here anything.

was this a reply to my post?