Residencies and Fellowships

[Richard_Hom]

Dear Dr. Doan,

I remember UC Davis once had a 4-year residency program for ophthalmology. Has that program retrenched to 3-years? Are there any 4-year programs in existence?

How important are fellowships? Do you feel fellowships really endow a prospective ophthalmologist with the experience or credibilty to be anointed a subspecialist?

How does the Navy feel about subspecialization amongst its ophthalmologists?

Thanks for your thoughts,
Richard

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[Andrew_Doan]

Originally posted by Richard_Hom
Dear Dr. Doan,

I remember UC Davis once had a 4-year residency program for ophthalmology. Has that program retrenched to 3-years? Are there any 4-year programs in existence?

How important are fellowships? Do you feel fellowships really endow a prospective ophthalmologist with the experience or credibilty to be anointed a subspecialist?

How does the Navy feel about subspecialization amongst its ophthalmologists?

Thanks for your thoughts,
Richard

Dear Dr. Hom,

Iowa was once a 4 year program but switched to a 3 year program. There are only a couple of 4 year programs left (unless they have changed too). Most are 3 years now. UC Davis is a 3-year training program (http://www.ucdmc.ucdavis.edu/ophthalmology/Education.html).
The 4th year at Iowa was really a 1/2 year for residents to be a junior faculty and staff cases. Most programs have enough patient volume, so there is not a need for the 4th year.

In regards to fellowships, the training and surgical experience is intensive. Fellows manage the extremely difficult cases and complete an incredibly large number of surgeries in their field of speciality. Fellowships are extremely important if an ophthalmologist plans to do complex eye surgeries, for instance: reconstructive oculoplastics (I've seen some really horrific dog maulings, MVAs, errosive cancers, etc...), retina surgery, difficult glaucoma cases, corneal transplants, or strabismus surgery (pediatrics). Clearly, neuro-ophthalmologists and ocular pathologists will need to complete fellowship training. After fellowship training, these individuals are truly sub-specialists.

While general ophthalmologists are capable of doing simple lid surgeries, glaucoma filtering procedures, and muscle surgeries, there are always cases that require a fellowship trained surgeon. An important note is that fellowship trained physicians will see hundreds of rare cases/difficult surgical patients per year while the general ophthalmologist may only see 2 or 3 per year. Because of the huge difference in the volume and type of patients seen by fellowship trained physicians, these sub-specialitists have the experience and abilities that their general ophthalmologists do not.

The Navy recognizes that sub-specialists are important individuals in military medicine. The Navy sends approximately 2 general ophthalmologists per year for fellowship training). The Navy has a complete line of sub-specialists: retina, ocular pathology, cornea, glaucoma, pediatrics, neuro-ophthalmology, oculoplastics, and refractive surgeons. The fellowship trained ophthalmologists are assigned mainly to one of the three major teaching hospitals: San Diego, Portsmouth, and Bethesda. The other billets are usually filled by general ophthalmologists.

 

[Richard_Hom]

Dear Dr. Doan,

1. When should or would a general ophthalmologists "admit" to an optometrist or a patient that a case "is over their head"?

2. What would be an appropriate approach to "interview" a general ophthalmologist about the degree of comfort about a particular case?

Thanks,
Richard

 

[Andrew_Doan]

Originally posted by Richard_Hom
Dear Dr. Doan,

1. When should or would a general ophthalmologists "admit" to an optometrist or a patient that a case "is over their head"?

2. What would be an appropriate approach to "interview" a general ophthalmologist about the degree of comfort about a particular case?

Thanks,
Richard

Dear Dr. Hom,

The answer to the first question depends on the experiences of the general ophthalmologist. General ophthalmologists will vary in regards to their expertise depending on their training and practice. I think if there is any question about diagnosis or if the patient is not responding to therapy, then a consultation is needed. This requires diligent patient follow-up. A second opinion is always helpful.

In regards to optometrists referring to general ophthalmologists, I think it is appropriate to discuss the patient with the MDs and then ask if they are comfortable evaluating the patient. If the MDs are not comfortable, then they will usually recommend consultation to the appropriate sub-specialist. I think it is reasonable to refer to a general ophthalmologist who you trust, and let the physician decide if further evaluation by a sub-specialist is needed.

Best regards,

 

[Richard_Hom]

Dear Dr. Doan,

In what circumstances would it be appropriate for an optometrist to refer directly to a subspecialist?

Originally posted by Ophtho_MudPhud
I think it is reasonable to refer to a general ophthalmologist who you trust, and let the physician decide if further evaluation by a sub-specialist is needed.

Regards,
Richard

 

[Andrew_Doan]

Originally posted by Richard_Hom
Dear Dr. Doan,

In what circumstances would it be appropriate for an optometrist to refer directly to a subspecialist?



Regards,
Richard

Dr. Hom,

I think consultations with a subspecialist is indicated if one is sure of the diagnosis and the condition requires the expertise of a fellowship trained ophthalmologist.

For instance, a patient walks into your office with complaints of new floaters and photopsias. A dilated exam reveals a rhegmatogenous retinal detachment. Direct consultation with a retinal specialist is warranted.

Another example is a glaucoma patient who doesn't respond to therapy with continued vision loss. Prompt referal to a glaucoma specialist would be appropriate.

I think that if optometrists have general ophthalmologists who they trust, then it wouldn't hurt to discuss the case first with them. However, as stated above, if one is sure of the diagnosis and that treatment should be done by a fellowship trained ophthalmologist, then direct consultation with a subspecialist is needed.

Regards,
Andrew