Support California's Bill for Optometry--SB 1406

[Oculomotor]

OD's in California have a patient-unfriendly optometry law that has unecessary restrictions placed on OD's for glaucoma treatment, prescriptive authority, even doing in office lab tests (glucose monitoring). This new bill SB 1406 will correct that nonsense! Keep in mind that the Medical--Ophthalmology side will say that the bill OPENS the door for all ophthalmic surgery but in reality to get what "you really want" (ie.. glaucoma treatment, open prescribing, etc..) you have to introduce a bill that has "much more" in it and it wil be "compromised down" to what you are really after......Support S1406!!!!!

What SB 1406 Does:

• Removes existing statutory restrictions on optometric practice that operate as barriers to efficient, effective primary care, and
• Redefines the regulatory model for optometry in a manner consistent with medicine and dentistry in California, and optometry as practiced in most other states.

Senate Bill 1406 as introduced defines optometric scope of practice generally, and delegates responsibility for licensing, setting qualifications, and enforcement to the State Board of Optometry and properly-accredited professional entities – as is now the case for Medical Doctors, dentists, and podiatrists.
Why is SB 1406 Needed?

One of the core values of the California Optometric Association and the state's 6,000 Doctors of Optometry is a commitment to expanding access to primary health care. Optometrists are on the front line of eye and vision care and understand more than most providers how early diagnosis and treatment of conditions like diabetes and cancer can save heartache and millions of dollars downstream.
While current health care reform proposals rightfully look at expanding care and shaving costs, the issue of a critically needed expanded work force has largely been unaddressed. One obvious solution to this problem is to allow all health care providers to practice to the full extent of their training thus enabling more patients to be treated at lower cost than generally charged by medical doctors.
Seven out of 10 eye care patients see an Optometric Doctor first; for many of them the optometrist is the first – and, sometimes, only – health care provider they will see. Given that there are almost 6,000 actively-licensed California ODs, it only makes sense to capitalize on their numbers and geographic distribution to get more and better primary care services to as many of our citizens who need them as possible. If permitted to practice as trained, optometrists could treat many more patients efficiently and more economically and get them into necessary treatment provided by other practitioners faster.
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What ODs are Trained to Do


Optometric Doctors (ODs) are essentially "primary care specialists" – that is, they are extensively educated and trained through four years' postgraduate study, externships, and residencies to diagnose and treat all diseases and abnormalities of the visual and associated systems. Optometrists can do much more than measure and correct vision and prescribe and fit lenses. Using as many as 26 distinct measurements of the patient's ocular (eye) and neurological (nerve pathways) systems in comprehensive eye exams conducted in their offices, they are qualified to diagnose and either treat, manage, or consult for treatment patients who have:

• Vision problems that affect neurological development, learning, balance, and on-the job performance.
• Eye disease.
• Cataracts.
• Corneal disease.
• Retinal detachment.
• Glaucoma.
• Diabetes.
• Hypertension.
• Pre-cancerous and cancerous tumors.
• Vascular disease.
• Viral and other diseases revealed through the eye.
• Foreign bodies or lesions of the eye and related structures.

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Current California Law for MDs and ODs

California's law licensing "physicians and surgeons" – Medical Doctors, or MDs – defines what they can do, consistent with their education and training in fairly simple, straightforward terms. A single license covers all medical subspecialties, which are credentialed not by the state but by private, national medical bodies. The Medical Board of California defines the Legislature's general grant of authority through regulation and protects the public through enforcement. By contrast, the legislative scope of practice of Optometric Doctors spells out in detail what they cannot do, in relation to MDs, rather than by what they are trained and qualified to do. There are in essence five levels of optometric practice based on certifications dictated by the Legislature, and the State Board of Optometry has little discretion to interpret those requirements. If the "medical model" works for Medical Doctors and protects the public from unreasonable risk, wouldn't an "optometric model" perform the same function, as well?
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Current Medicare Law & the Future

Since 1988, Optometric Doctors have been defined in the Social Security Act as "physicians," for purposes of the Medicare program. As such they are permitted to provide both vision and medical eye care services on the same basis as Medical Doctors, up to the level of scope of practice authorized by the States in which they practice. If current restrictions on California optometrists were removed or relaxed, nearly 6,000 practitioners could provide higher levels of therapy and management to our ever-growing Medicare population.
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CURRENT RESTRICTIONS ON –

Glaucoma Diagnosis & Treatment:

Currently, only "certified" Optometric Doctors are authorized to treat and are limited to primary, open-angle glaucoma in patients over 18 years of age. To become certified, each OD must complete 24 hours of didactic instruction from one of our accredited schools of optometry and must treat 50 glaucoma patients "in collaboration" with an ophthalmologist (Medical Doctor specializing in eye care, or "OMD") "for a period of two years for each patient." This "collaborative" process, consisting of nine separate, statutory preconditions that must be fulfilled before the OD can be certified to treat patients without direct supervision, depends on the availability and active cooperation of a consulting OMD.
Given the length of time required, the cost and logistics involved in meeting all the conditions imposed, and the fact that ODs and OMDs compete for some of the same vision care patients and there are fewer than 2,500 California-licensed OMDs available – assuming they're willing to do so – this "expansion" has proved to be a failure. As of November 2007, fewer than 110 optometrists out of nearly 6,000 licensees had been certified to treat glaucoma patients, even on a limited basis.
Even assuming optometrists were authorized to treat all glaucoma patients as trained, their limited ability to prescribe necessary medications or utilize available procedures would still be a barrier to effective care. (See "Prescribing and ‘Co-management'" and "Surgery," below.)
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Eye-related Disease Diagnosis and Treatment:


In addition to all the restrictions imposed on optometric diagnosis and treatment imposed by limitations on the use of prescribed drugs, Optometric Doctors cannot use a variety of procedures they may be trained or certified to perform in their offices to diagnose and treat eye conditions and diseases, including:

• Access to any new, FDA-approved ophthalmic technology they're qualified to use in caring for their patients.
• Utilizing in-office imaging, full laboratory panels, and other available and appropriate diagnostic tools to support disease detection, management, and referral.
• A variety of minor surgical procedures requiring only local anesthesia.
• Removal of external foreign bodies.
• Punctal occlusion using methods other than mechanical insertion of plugs.
• Full treatment of the lacrimal system in patients of all ages.
• Diagnosing and treating anterior segment or other conditions using laser technology brought into use after January 1, 2001.

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Prescribing and "Co-management:"

To be certified to use or prescribe any legend substance at all, other than to dilate eyes, an Optometric Doctor must satisfy a laundry list of statutory requirements, depending on whether he or she graduated from optometry school before January 1, 1992; January 1, 1996; or January 1, 2000, to become "Therapeutic Pharmaceutical Agents (TPAs) certified." Because every optometry student who's graduated after January 1, 2000 has had to pass a three-part national licensing examination administered by the National Board of Examiners in Optometry, these staged certification requirements have become obsolete.

Overall, ODs in 42 other states have more liberal TPA prescribing authority by category of medication than in California; moreover, "co-management" conditions imposed on individual optometric use are more onerous than almost everywhere else. Current restrictions include:

• California is one of only eight states that do not permit ODs to prescribe oral drugs to treat glaucoma.
• California is among the minority of states that do not allow optometrists to use the most effective oral anti-inflammatories, such as corticosteroids.
• An OD may not prescribe any medicine for a child less than one year old.
• An entire system of the eye is excluded from optometric treatment of anterior segment and adnexa infections and treatment of AIDS patients for infections is forbidden.
• When using topical (i.e., applied to the surface) steroids to treat eye allergies, an OD must either "consult" with or "refer" to an ophthalmologist (OMD) in four distinct circumstances and in the presence of three specific conditions.
• An OD may not use more than two topical medications concurrently to treat primary open angle glaucoma – and one drug with two agents counts as two – and must refer to and OMD if "treatment goals are not achieved…or if indications of narrow angle or secondary glaucoma develop."
• If a glaucoma patient has diabetes, the OD must "consult in writing" with an MD in developing the treatment plan and notify him or her in writing of any medication changes – which the MD must confirm, also in writing.
• If using oral antihistamines for eye allergies, an OD must refer "if the patient's condition has not resolved three days after diagnosis."
• Oral antibiotic use by ODs to treat eye infections is limited to 13 specified classes and one of those is restricted; consultation with or referral to an OMD is mandatory in such cases under seven specific circumstances involving length or progress of treatment.
• ODs may treat only eight viral eye conditions or infections, subject to specific progress and length of treatment restrictions requiring OMD consultation or referral, and may prescribe only one oral antiviral medication, which is limited in its effectiveness.
• For pain relief, ODs are restricted to two classes of narcotic, or "scheduled" (codeine and hydrocone, with compounds) drugs, nonscheduled oral analgesics, and may prescribe for only three days, "with a referral to an ophthalmologist if the pain persists."
• For every required consultation, the OD must document in writing all interactions with the OMD and furnish a copy upon request.

In all cases where restrictions on optometric treatment are imposed or ophthalmologic consultation or referral is required, the economic and logistical costs to individual patients increase automatically.
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Injections

The only injection an OD is authorized to perform is to "counter anaphylaxis," which no license is required to perform for this self-defining emergent condition. Combined with the prohibitive definition of "Surgery," this means that an OD trained to diagnose diabetes through the retina cannot perform a finger stick to measure blood glucose levels.
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Surgery



Section 3041(i) of the Business and Professions Code states as follows:

"Notwithstanding any other provision of law, the practice of optometry does not include surgery. "Surgery" means any procedure in which human tissue is cut, altered, or otherwise infiltrated by mechanical or laser means in a manner not specifically authorized by this act. Nothing in this act amending this section shall limit an optometrist's authority, as it existed prior to the effective date of the act amending this section, to utilize diagnostic laser and ultrasound technology." [Emphasis added.]​

This current definition of "surgery" is so restrictive that it prohibits the withdrawal of blood samples or administration of any kind of intramuscular or intravenous procedures – things that other health care licensees with a fraction of the training undergone by optometrists do routinely. (Combined with additional restrictions on treatment of punctual occlusion and foreign body removal, it's a clinical strait jacket.) Not only that, it freezes in time an optometrist's ability to use progressive, diagnostic laser and ultrasound technology for any purpose.

WANT TO WEIGH IN?

Call or write you legislators and let them know you support SB 1406 because it will allow your optometrist to do more to take care of you in one visit, at less cost to you and your insurance plan.
Don't know who your legislators are? Click here and enter your street address and ZIP Code. You'll be taken to a page that lists your Assembly Member and State Senator by name, along with their Capitol and District office addresses and telephone numbers. (Click on a legislator's name to visit his or her California Legislature home page.)



Optometrists----The Primary Eye Doctors......

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Members don't see this ad.

 

[IndianaOD]

any OD currently practicing in CA or who may in the future needs to take immediate action! Don't think others will do your work for you!

 

[sniklegem]

SERIOUSLY!
All students especially from CA or looking to practice in CA should contact their senators ASAP and get your voice heard!
I just got back from the national AOA-PAC conference and I found out that students can sometimes be more convincing than docs.

 

[IndianaOD]

Also ophthalmology currently has an OD smear legislative campaign going on with regards to medicaid.

 

[sniklegem]

Ophthalmology hosted their DC conference the day we concluded ours. Coincidence, I think not.

 

[cunikki]

haahaha that was pretty funny though when you got back to the hotel to do the debriefing there was one light sign on the wall that said aoa and one that said ophthalmology. and none of the omds i saw looked too happy about it

 

[Oculomotor]

"haahaha that was pretty funny though when you got back to the hotel to do the debriefing there was one light sign on the wall that said aoa and one that said ophthalmology. and none of the omds i saw looked too happy about it "


That is hilarious!!! Did you get a chance to interact with any of them (i.e.---"Hello, how's it going?", etc) ? All I know is that I would have loved to have seen that!

 

[cunikki]

i unfortunately did not get to.. but another student from my school said that they saw someone complaining to the staff at the hotel....
i was just amused when we went out to capitol hill to talk to the congresspeople and all the optometrists are just dressed up in regular nice clothes and all the mds have GIANT nametags on their clothes that say john doe, MD (just in case we werent sure)

 

[sniklegem]

Rule #1- Don't wear your name tag & lanyard. It looks stupid.

 

[IndianaOD]

http://www.youtube.com/watch?v=ACXSQchfs7g

Pretty good video, you should pass it on.

 

[ronk]

SB 1406 was thankfully stricken down.

The youtube video was extremely deceptive.
http://www.youtube.com/watch?v=ACXSQchfs7g

How can somebody say that 4 years of graduate school, i.e. optometry school, is "nearly the same amount of time as an ophthalmologist"? This is incorrect and explicitly misleading. We all know that 4 years of optometry school doesn't equal 4 years medical school + 4 years of residency.

"We want the right to practice optometry to the level we have been trained." If this were true, then we would not be talking about having optometrists perform surgery. Without years of direct knowledge and experience talking to patients (including children and their parents), families, and loved ones about the serious nature of surgery, discussing and dealing with life-changing outcomes and complications (including death), and having a direct and thorough familiarity with other medical specialties, how can one attempt to enter the arena of serious medical and surgical practice? I do not think that legislation automatically gives one the knowledge and experience to do many of the things proposed in the bill.

The point about access to eye doctors is a good one. That is to say, that the aging population will cause an increased demand for all forms of medical care. However, that does not mean that we should legislate that allied health professionals (e.g. optometrists) to function as physicians (i.e. medical doctors/surgeons). If there are not many spinal surgeons in an area (not much access), should chiropractors be legislated into having the ability to perform such surgery? Even if they have had 4 years of chiropractic school (the same as medical school and optometry school, gasp!), and have observed other people perform surgery and have read textbooks about surgical subjects, but never had training in surgery?

And 100 classroom hours of pharmacology in optometry school is more than medical students receive? That statistic has to be wrong (based on my personal experience and those of my friends from dozens of medical schools across the country). And although meant to impress the lay public, is really not that much.

Basically, this bill and the "bullet points" made in the video are a snapshot of legislation happening all around the country on the state and federal level. Attempts to deceive the public into believing that the training of optometrists and ophthalmoloists are equivalent are dangerous methods to allow ODs to obtain legal precedent to use ophthalmic/medical billing codes.

Back to the bill, if you want the exact languange proposed:

This bill:
1)Revises and recasts those provisions to instead provide that an optometrist who is certified to use therapeutic pharmaceutical agents may:
a) Diagnose and treat the eye, or any part of the visual system, for any of the conditions that he or she is trained and authorized by the Board to diagnose and treat.
b) Use any TPA he or she determines to be necessary.
c) Perform minor surgical procedures not requiring general anesthesia any test or procedure necessary for diagnosis of the visual system.
d) Perform lacrimal irrigation and dilatation necessary for diagnosis of the visual system.
e) Injections necessary for diagnosis and treatment.

Have you ever seen somebody develop a hemorrhagic stroke after receiving TPA?
How many optometrists would know how to treat a retinal detachment or malignant glaucoma as a complication of intravitreal injection? Or a penetrated globe after a sub-Tenon's injection? How would you know if your push with the lacrimal probe did not result in entering ethmoidal sinus or penetrating the cribiform plate?
Everyone knows the answer to these rhetorical questions. Just imagine if your parents needed one of these procedures. Would you send them to an experienced ophthalmologist, or to an optometrist who was legislated into having the ability to do so by a misled legislative assembly?

And if you have lots of time, read the edits in the bill:
http://www.leginfo.ca.gov/pub/07-08/bill/sen/sb_1401-1450/sb_1406_bill_20080221_introduced.pdf

 

[Graham Lakkis]

This bill:
1)Revises and recasts those provisions to instead provide that an optometrist who is certified to use therapeutic pharmaceutical agents may:
a) Diagnose and treat the eye, or any part of the visual system, for any of the conditions that he or she is trained and authorized by the Board to diagnose and treat.
b) Use any TPA he or she determines to be necessary.
c) Perform minor surgical procedures not requiring general anesthesia any test or procedure necessary for diagnosis of the visual system.
d) Perform lacrimal irrigation and dilatation necessary for diagnosis of the visual system.
e) Injections necessary for diagnosis and treatment.

Have you ever seen somebody develop a hemorrhagic stroke after receiving TPA?

Um, TPA means therapeutic pharmaceutcal agents (in this context), not tissue plasminogen agent.

 

[prettygreeneyes]

Have you ever seen somebody develop a hemorrhagic stroke after receiving TPA?

As has already been pointed out... huh??? I don't think we're talking about the same TPA here...

 

[ronk]

my bad on the TPA.

 

[IndianaOD]

my bad on the TPA.

:troll:

Are Oklahoma ODs killing and blinding people. Lets get real.

Med school teaches VERY little about eye care. OMDs get everything in their 3 years of OMD residency. Enough of the dramatizing

 

[qwopty99]

SB 1406 was thankfully stricken down.

Congratulations on your victory.

 

[Absolute Vision]

The SB 1406 was passed in CA on 9/26/08 and signed by Gov Schwarzenegger, and the provisions will take place at the start of 2009. Here is the link to how the SB 1406 changes existing law: http://www.my-eyedoc.com/senate_bill_1406.php.

The link to the final approved SB 1406 document is: http://www.leginfo.ca.gov/pub/07-08/bill/sen/sb_1401-1450/sb_1406_bill_20080926_chaptered.pdf

 

[362.04]

Ronk,

Not only are you lost and unfamiliar about OD topics, I'm wondering what was the purpose of your post. What kind of contribution are you offering?

 

[ronk]

The SB 1406 was passed in CA on 9/26/08 and signed by Gov Schwarzenegger, and the provisions will take place at the start of 2009. Here is the link to how the SB 1406 changes existing law: http://www.my-eyedoc.com/senate_bill_1406.php.

The link to the final approved SB 1406 document is: http://www.leginfo.ca.gov/pub/07-08/bill/sen/sb_1401-1450/sb_1406_bill_20080926_chaptered.pdf

Thank you for the links. My point in stating that the bill was "stricken down" was in the context of the provisions to perform surgery.

Congratulations on your victory.








I'm not pro-surgery at all, but I have an issue with arrogant MDs.

I'm sure there'll be another "SB 1406" in California or elsewhere on the horizon in no time...


Last laugh.

This statement disheartens me. You have an issue with "arrogant MDs," of which we have all met (as well as arrogant ODs, JDs, PhDs, police officers). However, despite your position being "not pro-surgery," you still seem to imply support by awaiting "another 'SB 1406'". I hardly think that these important issues should be determined by superficial reasons and not the pertinent facts of the issue. There are expansion of optometric scope of practice in nearly every state. If you are against optometrists performing surgery, please support this issue.

:troll:

Are Oklahoma ODs killing and blinding people. Lets get real.

Med school teaches VERY little about eye care. OMDs get everything in their 3 years of OMD residency. Enough of the dramatizing

I am not sure if Oklahoma ODs are killing and blinding people. I do not know the statistics of that. However, let me be clear that complications of surgery include death and blindness. They unfortunately happen in every state every year even in the hands of experienced surgeons. Please do not play down the fact that these things happen.

Regarding the comment on medical school teaching little about the eyes and residency being the primary source of ophthalmic education, this is a mostly true statement. (Although each person's medical school experience in a given specialty may differ based on many factors, including the student's own interest and the ophthalmology department's availability of rotations, etc.) I believe it is in response to the clarification of the number of years of training for ophthalmologists in my post. My point was that the youtube statement was extremely misleading. My language was not dramatic or misleading. It was a statment of fact.

Ronk,

Not only are you lost and unfamiliar about OD topics, I'm wondering what was the purpose of your post. What kind of contribution are you offering?

Thank you for your comment. The pupose of my comment to this thread was in the second line of my post: "The youtube video was extremely deceptive." This was followed by specific cited examples. In this forum, there are many people reading: practicing optometrists, optometry students, pre-optometry students, ophthalmologists, and casual readers. I believe it is important to have truth in advertising pieces, such as the optometry video posted on youtube. Otherwise, it gets degraded to propaganda, which is filled with half-truths or un-truths aimed at inciting a misinformed reaction in the audience.

I thought my contribution was in explicitly pointing out some of the misleading statements in the video so that people can receive some clarification and rebuttal to some of the statements.

I look forward to additional comments on the original poster's thoughts or my own.

 

[362.04]

"...I thought my contribution was in explicitly pointing out some of the misleading statements in the video so that people can receive some clarification and rebuttal to some of the statements..."

Dear Ronk,

It is my perception that "educating" or "clarifying" with an attitude automatically raises the specter of another "anti-OD" rant. I must admit, I don't believe your clarification was done in a "positive spirit". I'm always surprised how well intended individuals can go astray due to their own bias that everyone else is wrong and they are right. Forgive me if I have misperceived you. I always say that quacks like a duck, talks like a duck..is a duck.

 

[Oculomotor]

Ronk (or whatever your moniker is--lol)

You obviously have a "topical" understanding of how legislative efforts work. 99% of California OD's don't want more than minor surgical procedures (ie punctal, plugs, anterior stromal micropuncture, FB removal, etc...) so they created a HUGE bill to get some changes successfully through which many changes actually made it through. You have no adequate frame of reference as to what optometrists are capable of doing and just like most of your counterparts in the ophthalmology world you care about 1) protection of your income 2) turf protection and 3) keeping up your "nice" referral base from OD's. Everything you mentioned about the "thousands of deaths" LOL that would be caused by OD's doing surgical procedures is utter nonsense. OD's can EASILY be trained to do PRK, SLT's, ALT's, YAGs, etc....I have been on rotations with some that have been in Oklahoma and talked to OD's that practice there. DUDE, JUST BE HONEST MAN!!!!! You could train a monkey to do some of that stuff------FOR REAL! I just think that Organized Ophthalmology just needs to get it's head out of it's ass. An OMD that I was with recently told me straight up (family friend), "Behind closed doors we (ophthalmologists in this state) know that OD's are primary eye care docs and for the most part do a good job and know their limits. Publically organized medicine or ophthalmology will not admit it though-----it is politics."

He just stays out of political stuff and watched on the sidelines as both sides fought over an optometric expansion bill and rakes in tons of OD referrals$$$$$. Smart and Rich man indeed. In the end, the bill had 80% of its original intended changes pass-------A resounding success. But the Ophthalmology spin was," We have successfully and drastically changed the optometric community scope changing bill to protect patients and our profession from an grave threat. blah blah blah....."

You know want to know what the "grave" threat was?

1) Adding Schedule III-V narcotics for "short-term" comfort care of acute eye pain.
2) having completely open oral drug classes no restrictions (formulary) of ocular indicated drugs
3) epinephrine to treat anaphylactic shock
4) injectable ocular drugs
5) glucose monitoring devices
6) and some other minor ramblings

OPTOMETRIC ARMAGEDDON!!!! or in reality stuff that 40+ states already have (with the exception of ocular injectables)

----In the end all 6 except (5) injectable ocular drugs passed. like I said about 80% got through. Even the legislators could see through the "scare" tactics from medicine's side.......Even they were getting sick of it--because it is a TIRED-CIRCULAR ARGUMENT!

Optometry has been successful in the last 40 yrs in gaining TPA privileges in all 50 states because they carried on an Agonistic approach emphasizing "patient access to care" while medicine had (and still has) an antagonistic approach using "degradation and fear tactics" unwittingly painting itself as the "antagonistic other".

So Ronk, I just have to tell you that we can all see through your "scare" tactics too----------go to the OMD forum and I am sure all of your friends there will agree with your propaganda.

word up.

 

[Oculomotor]

Peace.................

 

[IndianaOD]

REALITY CONFIRMED - it is all about money. Always has been for the OMDs. I don't think nearly as many ODs are strictly in it for the money. A dentist has the same level of training and averages twice the income.

Ronk. Before you say anymore in this thread look at the safety profiles of expanded OD scope. The record is impeccable.

ODs have doctoral level training, yet tattooists and piercing workers can perform more invasive procedures. This is what tells me its all about the money.

 

[qwopty99]

This statement disheartens me. You have an issue with "arrogant MDs," of which we have all met (as well as arrogant ODs, JDs, PhDs, police officers). However, despite your position being "not pro-surgery," you still seem to imply support by awaiting "another 'SB 1406'". I hardly think that these important issues should be determined by superficial reasons and not the pertinent facts of the issue. There are expansion of optometric scope of practice in nearly every state. If you are against optometrists performing surgery, please support this issue.

I'm not pro-surgery. I have no opinion on the issue. I've always maintained this position - you're not too active on these forums so you're probably unaware of this.

 

[ronk]

Ronk (or whatever your moniker is--lol)

You obviously have a "topical" understanding of how legislative efforts work. 99% of California OD's don't want more than minor surgical procedures (ie punctal, plugs, anterior stromal micropuncture, FB removal, etc...) so they created a HUGE bill to get some changes successfully through which many changes actually made it through.

Thank you for your explanation of how legislative efforts work. The insertion of additional and often far reaching provisions in legislative bills, with the knowledge that the contents will be amended during the process, is not a concept naive to me or anybody else reading this (I hope). However, this particular provision is not a minor one and is thus a focus of my commentary. Please read my previous post and further commentary below on my opinions of surgery. If one percent of California's optometrists (approximately 60 optometrists based on the statistic in the youtube video) do wish to do more than "minor surgical procedures" (which I oppose anyways), then I do believe that those individuals should be trained to be surgeons (i.e. medical school and residency), instead of having a bill passed giving them permission to perform surgery.

You have no adequate frame of reference as to what optometrists are capable of doing...

I can comment on the capabilities and knowledge of the optometrists that I have personally worked with. They are highly intelligent, capable, and personable people who work in private or university settings. We share many patients and depend on each other for our own areas of expertise. We have a high level of mutual respect for our capabilities and decision making. Some have been extremely competent in managing various ocular conditions, including glaucoma. The optometry students that I have worked with in various VA hospitals in several states have been generally good. I cannot comment on things they may be capable of doing that I have not observed, e.g. if they can perform removal of deep, central corneal bodies; or if they can perform a good YAG capsulotomy.
However, I have been referred many patients from some optometrists who have been not been capable of making correct diagnosis or managing disease appropriately.
I do not know if you, as an optometry student, are capable of doing PRK. So if that is the basis of your question, then you are correct.

...and just like most of your counterparts in the ophthalmology world you care about 1) protection of your income 2) turf protection and 3) keeping up your "nice" referral base from OD's.

I do not think that your assumption of what I care about is fair, and is not correct. My primary focus is for patient safety. There is no question that both parties involved have financial incentive. Optometrists may say that ophthalmologists are trying to protect income and turf, while ophthalmologists may say that optometrists are trying to expand their income and turf. I do not intend to try to point fingers and determine who is less right.

Everything you mentioned about the "thousands of deaths" LOL that would be caused by OD's doing surgical procedures is utter nonsense.

I have never quoted any number, and deaths are obviously not in the thousands. Although it is fair to say that hundreds of people lose vision after ophthalmic surgery for multiple causes, e.g. retinal detachment, malignant glaucoma, ischemic optic neuropathy, retrobulbar hemorrhage. Additionally, our older patients have many comorbidities which often require post-surgical hospitalization. But my point was to reiterate that surgical (and medical) intervention is not benign and there are clearly risks that anybody performing surgery should understand thoroughly.

OD's can EASILY be trained to do PRK, SLT's, ALT's, YAGs, etc....I have been on rotations with some that have been in Oklahoma and talked to OD's that practice there. DUDE, JUST BE HONEST MAN!!!!! You could train a monkey to do some of that stuff------FOR REAL!

Your experience with those laser and surgical procedures sounds limited. To have talked to students and optometrists who have done/seen them hardly seems vast.
Surgical procedures do have different levels of technical difficulty. I agree that ophthalmologists, optometrists, and lay people can be trained to perform procedures. Suturing is also a technical skill that one can teach to an unintelligent person with manual dexterity. The point that you have not addressed is in the perhaps more important requirement of experience with judgment (to schedule surgery, intraoperative variations in anatomy) and management of complications (central corneal scars or haze, development of angle-closure glaucoma, other unexpected spikes in intraocular pressure after laser). Just because one knows how to turn on a laser, position a patient, and adjust the settings (which you said a monkey could do), doesn't make them capable of understanding the other factors involved.

I just think that Organized Ophthalmology just needs to get it's head out of it's ass. An OMD that I was with recently told me straight up (family friend), "Behind closed doors we (ophthalmologists in this state) know that OD's are primary eye care docs and for the most part do a good job and know their limits. Publically organized medicine or ophthalmology will not admit it though-----it is politics."

I agree that optometrists provide a level of primary care for some eye conditions. Saying that most people do a good job most of the time is probably OK for most jobs. But to giving wide privileges to untrained persons who do not do a good job and do not know their limits is a dangerous game in medicine.

He just stays out of political stuff and watched on the sidelines as both sides fought over an optometric expansion bill and rakes in tons of OD referrals$$$$$. Smart and Rich man indeed. In the end, the bill had 80% of its original intended changes pass-------A resounding success. But the Ophthalmology spin was," We have successfully and drastically changed the optometric community scope changing bill to protect patients and our profession from an grave threat. blah blah blah....."

I have read the original proposed bill and the bill signed by Governor Schwarzenegger. There are a number of changes that have been made. There are many that were not changed as originally proposed. Once again, something that is usual and customary in legislative bills. Many of the original proposed changes were in fact "grave," and I do believe that the amendments to the bill were necessary and will ultimately protect patients.

You know want to know what the "grave" threat was?

Yes. The provision: "(1) Minor surgical procedures not requiring general anesthesia and necessary to the diagnosis and treatment of a condition of the eye or visual system." That is grave, in my opinion.

1) Adding Schedule III-V narcotics for "short-term" comfort care of acute eye pain.
2) having completely open oral drug classes no restrictions (formulary) of ocular indicated drugs
3) epinephrine to treat anaphylactic shock
4) injectable ocular drugs
5) glucose monitoring devices
6) and some other minor ramblings

OPTOMETRIC ARMAGEDDON!!!! or in reality stuff that 40+ states already have (with the exception of ocular injectables)

----In the end all 6 except (5) injectable ocular drugs passed. like I said about 80% got through. Even the legislators could see through the "scare" tactics from medicine's side.......Even they were getting sick of it--because it is a TIRED-CIRCULAR ARGUMENT!

Sticking in a provision for injectable ocular drugs is a major point.

Optometry has been successful in the last 40 yrs in gaining TPA privileges in all 50 states because they carried on an Agonistic approach emphasizing "patient access to care" while medicine had (and still has) an antagonistic approach using "degradation and fear tactics" unwittingly painting itself as the "antagonistic other".

So Ronk, I just have to tell you that we can all see through your "scare" tactics too----------go to the OMD forum and I am sure all of your friends there will agree with your propaganda.

word up.

I use this forum as a way to express my opinion based on personal experience. I do not intend for the readers, whom I do not regard as the lay public, to be scared into an opinion. But rather, to provide the viewpoint that I personally have as an ophthalmologist. I have learned many opinions and points of view based on reading other posts within this forum. I look forward to reading other peoples opinions and posting responses and that is why I am here. Exchanging useful dialogue is important for both sides and is why I am here.

 

[ronk]

Dear Ronk,

It is my perception that "educating" or "clarifying" with an attitude automatically raises the specter of another "anti-OD" rant. I must admit, I don't believe your clarification was done in a "positive spirit". I'm always surprised how well intended individuals can go astray due to their own bias that everyone else is wrong and they are right. Forgive me if I have misperceived you. I always say that quacks like a duck, talks like a duck..is a duck.

Without question, I have my own opinion and bias about this topic, just as anybody else who posts messages. I believe the content my message was primarily in pointing out the misleading statements in the youtube video. Thank you for your comment on misperceiving me, since I think this was the case.

REALITY CONFIRMED - it is all about money. Always has been for the OMDs. I don't think nearly as many ODs are strictly in it for the money. A dentist has the same level of training and averages twice the income.

Ronk. Before you say anymore in this thread look at the safety profiles of expanded OD scope. The record is impeccable.

ODs have doctoral level training, yet tattooists and piercing workers can perform more invasive procedures. This is what tells me its all about the money.

I am not sure how reality was confirmed in your mind. Please let me know if anything I wrote or has developed in the news that has confirmed reality for you. However, I do agree that money is a factor in ophthalmology's push for surgery by surgeons, as well as optometry's push to expand their scope of practice via legislation. Nevertheless, this is not the focus of my position on this topic.
If you have it, please send me some information on the safety profiles of expanded scope of optometry. I have not been able to find government, state optometry board, or peer-reviewed data on this topic.
Optometrists are doctors of optometry, by definition and training. I do not see how tatoo and piercing artists are parallelled to the profession of optometry or surgery.

...if you're looking to pin "pro-OD-surgery" on me, you might want to come up with something a bit more precise than that...

I did not "pin" a position on you, but did imply your position based on your comments. If I am wrong, then I apologize.

...I wrote what I did because of the way you expressed your views. I don't care who you are. If you're a stupid-OD making idiotic partisan remarks, I'll come out and say it (and I have, on many occasions). Same goes with MDs.

So I wrote what I wrote in response to the insulting partisan "opinion piece" that you posted. I did it cause I wasn't going to challenge the content of what you wrote (I congratulated you), but since you made things personal, I did to. If you're going to laugh at us, I'm going to laugh at you.

I see based on this quote that you are writing/posting based on taking my comments personally. I feel that comments based on emotion or getting even rather than fact or reasoning is not useful in this discussion. You say that you posted what you did based on your distaste for "arrogant MDs." I also do not like arrogant people, but will not post a response do "laugh back."
If you wish to criticize "the way I expressed my views," then writing that in the first place would be more useful.

 

[362.04]

Ronk,

Let me further elaborate. I don't believe that your posts were useful in the least bit. If you want to rail against optometry, you have a more welcome forum in the ophtho forum.

I welcome posts on this forum that are constructive and instructive. Yours was neither. Its intent was not out of the goodness of your heart. I am tired of MDs, Pharms, ophthos and etc who feel that they know what is good for the optometric profession.

If you have nothing more constructive, then I feel that you should do what your chaps in the ophtho forum say, go elsewhere. The welcome mat is not open there to us. Ergo, I don't feel it should be put out for you either.

 

[IndianaOD]

Ronk,

Let me further elaborate. I don't believe that your posts were useful in the least bit. If you want to rail against optometry, you have a more welcome forum in the ophtho forum.

I welcome posts on this forum that are constructive and instructive. Yours was neither. Its intent was not out of the goodness of your heart. I am tired of MDs, Pharms, ophthos and etc who feel that they know what is good for the optometric profession.

If you have nothing more constructive, then I feel that you should do what your chaps in the ophtho forum say, go elsewhere. The welcome mat is not open there to us. Ergo, I don't feel it should be put out for you either.

Agreed. Other professions should piss off and let Optometry regulate itself. Perhaps we should be trying to dictate what OMDs are allowed to do. Certainly not as well trained in refractive eye care or binocular vision. Maybe they shouldn't be allowed to write spectacle and CL Rxs. Especially not RGPs. That's how stupid this turf war is.

 

[VA Hopeful Dr]

Ronk,

Let me further elaborate. I don't believe that your posts were useful in the least bit. If you want to rail against optometry, you have a more welcome forum in the ophtho forum.

I welcome posts on this forum that are constructive and instructive. Yours was neither. Its intent was not out of the goodness of your heart. I am tired of MDs, Pharms, ophthos and etc who feel that they know what is good for the optometric profession.
If you have nothing more constructive, then I feel that you should do what your chaps in the ophtho forum say, go elsewhere. The welcome mat is not open there to us. Ergo, I don't feel it should be put out for you either.

In all fairness, I don't think that was the goal. He seemed to be giving an opinion on what he thought was good for the patients, not what was good for optometry. I'm the local malcontent who thinks he knows, on occasion, what might be good for optometry. I'll fight tooth and nail to protect that turf.

 

[VA Hopeful Dr]

Agreed. Other professions should piss off and let Optometry regulate itself. Perhaps we should be trying to dictate what OMDs are allowed to do. Certainly not as well trained in refractive eye care or binocular vision. Maybe they shouldn't be allowed to write spectacle and CL Rxs. Especially not RGPs. That's how stupid this turf war is.

I'll agree on the CL end 100%. Glasses though? The last OD I went to had a tech do the entire refraction, didn't follow up behind her. The MD I used to work for did the exact same thing. I fail to see the difference.

That being said, if you're an OD who does your own refractions then I'll put you above the MDs anyday in that regard.

 

[qwopty99]

I did not "pin" a position on you, but did imply your position based on your comments. If I am wrong, then I apologize.

This is fine. Thank you.

 

[362.04]

In all fairness, I don't think that was the goal. He seemed to be giving an opinion on what he thought was good for the patients, not what was good for optometry. I'm the local malcontent who thinks he knows, on occasion, what might be good for optometry. I'll fight tooth and nail to protect that turf.

I had thought I misperceived his intent, but the more I hear or read his posts, his intent is clear. Let us also say that physicians are not the only ones who care about the patient and I don't believe that anyone has the complete monopoly on this. I trust you will understand that at a certain level that what drives each of us is a belief in the good of people, a supreme being or spirit that stimulates us to do good.

However, the more I hear naysayers, the more I think that some feel that optometrists are incapable of good intentions. In general, most optometrists seem to have better intentions than those who have posted as naysayers here.

I'm also quite tired of medical students, medical residents or ophtho residents butting in on this forum and acting like the "holy police". I don't think we need you. But alas, feel free to jump in and say something constructively. As of yet, there hasn't been one who has been.

 

[Oculomotor]

The bottom line (take home message) is:

1) Optometry evolved as a profession and is now occupying space with ophthalmology (ie. primary refractive eye care, primary medical eye care, etc)

2) Medicine-Ophthalmology does not want "competition" for the same potential revenue dollars with optometry.

3) Medicine has not had nearly the same fervor with professions like Dentistry, Podiatry, etc.. because "in general" there is not a medical equivalent like optometry-ophthalmology. They have attacked these professions when push comes to shove econmomically (plastic surgeons suing oral surgeons who practice facial cosmetic surgery---although in most cases the oral surgeons (OMFS's) rightfully won.)

4) Medicine does not want to share the "proverbial" spotlight with ANYONE----regarding Professional Respect and Public Perception. The more capabilities Optometrists get the greater the Public Perception of them.

5) Dangers to Patient Care , Fear Tactics, Legislative Bullying are core to the AMA's approach to sugarcoat the REAL agenda------> Turf, Professional Respect, and most of all MONEY!


MONEY MONEY MONEY MONEY MONEY MONEY MONEY MONEY MONEY

anyone who can't see this (due to blind indoctrination by Medical Education or any other education) is a complete IDIOT.

 

[DPMstudent]

3) Medicine has not had nearly the same fervor with professions like Dentistry, Podiatry, etc.. because "in general" there is not a medical equivalent like optometry-ophthalmology. They have attacked these professions when push comes to shove econmomically (plastic surgeons suing oral surgeons who practice facial cosmetic surgery---although in most cases the oral surgeons (OMFS's) rightfully won.)

Actually, a very similar situation has occurred/is still going on between podiatrists and foot and ankle orthopedics. The turf wars come more into play over surgical rights for the rearfoot/ankle. Optometrists are not alone in their batlles.

 

[Oculomotor]

DPMstudent.....You are absolutely right. The AMA has it's Scope of Practice Partnership "evaluating" all non-MD/DO professions to create fire to use against scope of practice expansion legislation by those professions. The report on Podiatry is complete and here are some excerps:

• Language the AMA uses in the podiatry module is decidedly antagonistic at times, with podiatric education termed "obsolete" and a reference to "great indifference from the profession of podiatry itself."
• In other cases, it's nonsensical, as in a passage referencing a 1993 California report on residency training: "The authors noted that clinical instruction in obstetrics, gynecology and urology is minimal in podiatry school…"
• Its tone can be condescending: "The authors did note that a podiatry resident training in an academic health center on an inpatient service does increase his or her functional level to that of a first-year medical student."
• Other times, it could best be described as snarky. For example, this parenthetical: "(The term 'rearfoot' is commonly used by podiatrists to mean what physicians term the 'hindfoot'….).

Topics covered in the podiatric module included an overview of the profession, demographics, education, residencies, fellowships, board certification and state licensure. According to the APMA, the information presented by the AMA was outdated, incomplete or even wrong."


This scathing review of Podiatry done by the AMA was intended to be given to state legislatures and govermental officials to "smear" podiatry. Guess what guys? The report on Optometry by SOPP will be completed late this fall---------------boy I bet that will be realllllllly positive

 

[DPMstudent]

DPMstudent.....You are absolutely right. The AMA has it's Scope of Practice Partnership "evaluating" all non-MD/DO professions to create fire to use against scope of practice expansion legislation by those professions. The report on Podiatry is complete and here are some excerps:

• Language the AMA uses in the podiatry module is decidedly antagonistic at times, with podiatric education termed "obsolete" and a reference to "great indifference from the profession of podiatry itself."
• In other cases, it's nonsensical, as in a passage referencing a 1993 California report on residency training: "The authors noted that clinical instruction in obstetrics, gynecology and urology is minimal in podiatry school…"
• Its tone can be condescending: "The authors did note that a podiatry resident training in an academic health center on an inpatient service does increase his or her functional level to that of a first-year medical student."
• Other times, it could best be described as snarky. For example, this parenthetical: "(The term 'rearfoot' is commonly used by podiatrists to mean what physicians term the 'hindfoot'….).

Topics covered in the podiatric module included an overview of the profession, demographics, education, residencies, fellowships, board certification and state licensure. According to the APMA, the information presented by the AMA was outdated, incomplete or even wrong."


This scathing review of Podiatry done by the AMA was intended to be given to state legislatures and govermental officials to "smear" podiatry. Guess what guys? The report on Optometry by SOPP will be completed late this fall---------------boy I bet that will be realllllllly positive

very interesting info. thanks! i hadn't read these quotes before. i find these threads interesting as i feel our professions are in similar battles quite often (plus western is opening a pod school too which may not be necessary, but thats a whole other topic). keep up the fight.

 

[qwopty99]

As for the other thread that was closed, I thought it was worth the editorial.

 

[Oculomotor]

qwopty99,

Your thread got closed because it was crazy!!!! (satire or not) Even KHE was shocked at how ridiculous and psychotic it was.
I may be an ass at times-----> I admit that but I am not crazy.

Fine, you make some reasonable points in your post but you don't have to insult and slam people for theirs..


You have that ridiculous "optometric surgeon" crap under your name----you are embarrasing yourself and the rest of us.---PLEASE REMOVE IT! There is no such thing as an optometric surgeon. (I know it is satirical but you and I both went way too far before with that and you are still doing it.-----I was wrong for doing that...I admit it.)

I am convinced you are on here just to pick fights with people.
I am allowed to have an opinion and it is just disconcerting that an OD (like you claim to be) can viciously attack optometry students on here. I am not trying to be mean to you but you just make me uncomfortable at times--lol.




What area is your FAAO in? Do you really like optometry?-------------serious question....

 

[Oculomotor]

DPMstudent,


Good luck to you guys as well---> I have always been a big supporter of Podiatry as I feel you guys should have unrestricted access to any part of the lower extremity and a full medical license for treatment thereof.

 

[qwopty99]

Hey - that's the reality of online forums...

 

[qwopty99]

What area is your FAAO in? Do you really like optometry?-------------serious question....

I do. And by the time I'm done with my career, I expect to have contributed a lot to this profession.

 

[IndianaOD]

I do. And by the time I'm done with my career, I expect to have contributed a lot to this profession.


Just last Wednesday, I attended a meeting at the National Ministry of Health in the country I'm working to discuss the passing of a license for optometry. There was an MD representing ophthalmology - when he got the microphone to make his case for why ophthalmology should control the destiny of optometry (his argument: they've taken courses in refraction) - I seized an available microphone and yelled (in my 2nd language) at him to identify which of the three lawmakers at the front (who had just walked in) didn't have the proper spectacle correction (I noticed the one in the middle was presbyopic - he was increasing his vertex distance to read). Of course the ophtho had no clue. I completely shut him up. He didn't contribute anything for the rest of the meeting, just sitting quietly in the corner (Ophthalmologists in such places like to present themselves as the authority on all things related to eyes - that includes refraction. Of course, that simply is not true).


Hmm... I'm conducting a CL study for one of the larger CL companies pretty soon, and am starting to get the ball rolling on publications.


I do like optometry. I just get annoyed by folks who help make the case to MDs that we're just idiots that shouldn't be trusted with anything. That includes a lot of the crap that I referred to in my satire and in my post above.

In terms of a positive contribution - Indy for instance, I think definitely has the authority to make compelling arguments for optometry - but he doesn't get past the partisan rhetoric. If he can do that (I would really like to see that), I think he is as well-equipped as any of us to really make a difference. Like, really. But the first step, is to acknowledge your opponent's position, then surreptitiously fit your own doctrine within the web of theirs. If it fits, how can they disagree?




BTW - I know a lot of my posts might seem like personal attacks on you. They really aren't intended that way - but you often make a good example of what I'm trying to point out, and therefore you're a really easy target...

Please understand, I in no way believe OMDs or MDs are idiots. I don't believe that OMDs and especially other MDs are better eye doctors than ODs period. While I personally have no interest, I support advaced practice optometry through further training as an option.

MDs used to (and still do) ridicule DOs. DOs have developed their own training programs and are basically seen as equals now in all aspects.

I would like to hear MDs on here show legitimate reasons and facts for their rhetoric. Throwing blind insults is juvenile.

 

[qwopty99]

I like to think I'm one of the bigger "defenders" of optometry in the OD/OMD fight threads.


Here's two recent shut-down replies against ophthos who were being dumb:

http://forums.studentdoctor.net/showthread.php?p=7163124#post7163124
http://forums.studentdoctor.net/showthread.php?p=7020013#post7020013

 

[qwopty99]

Please understand, I in no way believe OMDs or MDs are idiots. I don't believe that OMDs and especially other MDs are better eye doctors than ODs period. While I personally have no interest, I support advaced practice optometry through further training as an option.

MDs used to (and still do) ridicule DOs. DOs have developed their own training programs and are basically seen as equals now in all aspects.

I would like to hear MDs on here show legitimate reasons and facts for their rhetoric. Throwing blind insults is juvenile.

My belief in your abilities lies in the fact that you chose to complete a challenging residency at a top school. This speaks of your desire to learn and be the most competent practitioner you are able to be.

 

[IndianaOD]

My belief in your abilities lies in the fact that you chose to complete a challenging residency at a top school. This speaks of your desire to learn and be the most competent practitioner you are able to be.


It is this type of background that legitimizes your position that optometry deserves to be all it can be. Everything starts with able and competent practitioners - once this criteria has been met, can scope of practice issues be raised. Kinda like in NM (?) - ODs were doing "surgeries" safely for so long - when OMDs said they shouldn't be doing these things, the legislature simply redefined optometry to include surgery. This is what it takes to move optometry forward - and by your education you have done your part.


It is worth mentioning that not all ODs are as trained (or as good) as you. This is a fair argument. And this is where you have to hedge. However, these arguments become moot under a certain line of reasoning which I made in a post I made some time ago (the Roadmap to a Winning Legislative Lobby).

Yes, it is imperative that all ODs seek to provide the best care possible. Does take motivation. I've had 40/50 AAO points for the past year and keep trying to motivate myself to complete it!

 

[ronk]

If you're going to make these types of implied insults against optometrists on an optometry forum, then we're going to treat them as insults, and respond to them as insults.

I do not consider my use of the word "misled" to be an implied insult. I mean to use that adjective to describe the cited examples of descriptions in the youtube video. I won't repeat them, as they were fully delineated previously.

Don't tell me with "Hallelujah!" and "misled", that you didn't realize that your post had an insulting undertone to it? You really need us to tell you?

The intent of your post was clear from the first word to the last sentence.

"Hallelujah" may have been the wrong word.

The bottom line (take home message) is:...

...MONEY MONEY MONEY MONEY MONEY MONEY MONEY MONEY MONEY

anyone who can't see this (due to blind indoctrination by Medical Education or any other education) is a complete IDIOT.

I've addressed this. I agree with qwopty99 in the sense that the language used detracted from the intent of the post, although his use of words like "oculodork" and other language wasn't useful and was unnecessary.

...How can everyone be in complete disagreement, yet everyone be so mercilessly sure that they are correct?...

I also agree with this statement. I obviously think I'm correct.
But, I resurrected this thread since upon looking into California SB1406 and finding the video, I felt compelled to clarify. However, I am interested to learn about any new insights, facts, or studies about the topic.

In my search for more information on some of these topics, I found this report: http://www.nclnet.org/health/eyes/White Paper Final.pdf
I found it interesting and wanted to get opinions on it.

I believe the National Consumers League is an unbiased group that advocates for the American public.
http://www.nclnet.org/about/

qwopty99,...Fine, you make some reasonable points in your post but you don't have to insult and slam people for theirs...

Agreed. Civililty on this board would help.

...You have that..."optometric surgeon" crap under your name----you are embarrasing yourself and the rest of us.---PLEASE REMOVE IT! There is no such thing as an optometric surgeon. (I know it is satirical but you and I both went way too far before with that and you are still doing it.-----I was wrong for doing that...I admit it.)...

Agreed. Although if you would like to keep it to get a rise out of ophthalmologists and other surgeons, then nobody can stop you.

Please understand, I in no way believe OMDs or MDs are idiots. I don't believe that OMDs and especially other MDs are better eye doctors than ODs period.

Again, the training for optometrists and ophthalmologists is vastly different. This includes the type of pathology seen and the extent to which diagnosis and treatment is completed. I can't comment on who is a better eye doctor, since there are good and bad individuals in all jobs/professions. But I wanted to emphasize that the vast majority of optometrists see different types of disease than the vast majority of ophthalmologists.

DOs have developed their own training programs and are basically seen as equals now in all aspects.

Agreed.

I would like to hear MDs on here show legitimate reasons and facts for their rhetoric. Throwing blind insults is juvenile.

I would like to hear your comments on the National Consumers League report.

 

[KHE]

I would like to hear your comments on the National Consumers League report.

I am hesitant to get involved in this discussion because it almost never ends well, but I'm going to HOPE for a calm, rational discussion on this and I'm going to IMPLORE the usual hotheads to calm down a bit here in the interest of fostering a RATIONAL and REASONABLE discussion.

I'm not sure which report you are referring to, but most references to the NCL and the optometry/ophthalmology battles usually center around survey results that shows the public wants eye exams from MDs, or surgery from MDs, etc. etc.

I am hesitant to put a lot of validity into those types of surveys for a few reasons:

1) Surgery is rarely defined. The public has an idea of what they think "surgery" is but current CPT coding and terminology define as "surgical" countless procedures that the public would almost certainly NOT consider to be surgical in nature.

2) The questions are almost always poorly designed at best, or outright misleading at worst. For example, I saw a survey once (I don't believe it was the NCL) that asked a question similar to this: (I'm paraphrasing)

"Which doctor would you rather have perform eye surgery on your mother? Someone who went to medical school for 8 years and is fellowship trained in eye disease or someone who went to non-medical school for 4 years?"

Clearly, you can guess what the response of the public is going to be.

But to take the argument to an illogical conclusion, you can ask the following question in a survey format:

"Who would you rather have draw blood on you? A person who went to medical school for 8 years and is board certified in internal medicine or someone who took a community college course for 6 weeks?"

Clearly, you can guess what the response of the public is going to be for THAT question, even though most people who perform venipuncture and draw blood have little more than the training described.

I think it's also misleading for the NCL to state things like the public thinks optometrists have medical degrees and are board certified. They probably think the same things about dentists and yet no one wants to relegate dentists to scraping plaque and nothing else.

So in summary, I would NOT put a lot of value on that type of survey.

 

[IndianaOD]

I would like to hear your comments on the National Consumers League report.

I read through it and its not useful data at all. Almost sounds like and MD wrote it to be honest. Pretty skewed. Never says ODs had a poor safety profile.

Surveys on public perception can easily be skewed. For example, what if I asked people: Would you rather have an eye exam by me (an eye doctor with 5 years of eye-related training (A residency trained OD)) or an eye doctor with 3 years of eye-related training (a general OMD).

Not too hard. Overall, the report is not really a report and not useful.

 

[ronk]

I read through it and its not useful data at all. Almost sounds like and MD wrote it to be honest. Pretty skewed. Never says ODs had a poor safety profile.

Surveys on public perception can easily be skewed. For example, what if I asked people: Would you rather have an eye exam by me (an eye doctor with 5 years of eye-related training (A residency trained OD)) or an eye doctor with 3 years of eye-related training (a general OMD).

Not too hard. Overall, the report is not really a report and not useful.

I agree that surveys alone are subject to having a "slant." I have not read the actual language of the questions asked. Thus, cannot comment on that.

However, I have a few thoughts:

I thought that the language used in the report was accurate and fair. There were clear explanations of the training, role, etc. of opticians, optometrists, and ophthalmoligsts. Based on this fair language, I believe the questions and the subsequent explations to the survey takers was most likely not presented in a biased manner.

I thought the differences between the survey responses for the general public and the vetereans was interesting.

The almost equal travel time to different offices (i.e. access) was unexpected by many. Given that this was a survey, it only gives a slight insight into this issue. However, the SOPP may shed more light.

Never says ODs had a poor safety profile.

In fact, it cites some publications that report a very safe profile. If somebody can post the cited article (the one where Oklahoma optometrists reported almost 10,000 laser procedures without reported problems), it would be great for all of us to read.

Funk, D. “Optometrists Barred From Performing Laser Eye Surgery.” Army Times. January 17, 2005.

...I think it's also misleading for the NCL to state things like the public thinks optometrists have medical degrees and are board certified. They probably think the same things about dentists and yet no one wants to relegate dentists to scraping plaque and nothing else...

Can you please explain how it is misleading for the NCL to say that the public thinks optometrists have medical degrees and are board certified? It seems to me like a simple fact that this is the public's perception.
And I don't see how this translates to the dental issue.

-----------

In my experience, many patients referred to me from optometrists really don't know the difference between the two professions. As a simple example, many ask why they have to see me when they already have an eye doctor. They do not understand the role I play in their care, until I explain their diagnosis and/or treatment plan. Furthermore, they will call me an optometrist or call the optometrist an ophthalmologist. Do optometrists run into this similar situation?

------------

IndianaOD and KHE, it seems like you essentially dismissed the entire report, or white paper. Did you (or other optometrists) agree with any of the sections? Comments on access, legislative activity and implications, or framework for consumer eye care decisions?

If there are other consumer, governmental, or professional society reports that you know about, I would love to read them.

Thanks for your input.

 

[KHE]

Can you please explain how it is misleading for the NCL to say that the public thinks optometrists have medical degrees and are board certified? It seems to me like a simple fact that this is the public's perception.
And I don't see how this translates to the dental issue.

Sorry for the confusion.

There's nothing misleading about what the reports says, but it becomes misleading when ophthalmology uses that survey and surveys like it as a tool to protest against any sort of optometric scope of practice expansion. The argument is usually made "well, the public thinks ODs have medical degrees and are board certfied and since they don't and they're not, ODs shouldn't be allowed to do anyting other than prescribe glasses."

But I would be willing to bet $100 that most of the public thinks that dentists have medical degrees and are board certified as well. Yet no one is clamoring to reduce dental priviledges based on the arugment that they don't have MD degrees.

In the NCL report there is a section that mentiones that patients overwhelmingly think that people who do eye surgery should have medical degrees. They also want overwhelmingly for their eye care provider to have a medical degree. Fair enough.

But if you asked the question, you would almost certainly find that most respondents prefered their dental provider, or dental surgeon to have a "medical degree." Yet the public continues to safely and confidently get dental care from people who don't have MDs.

In my experience, many patients referred to me from optometrists really don't know the difference between the two professions. As a simple example, many ask why they have to see me when they already have an eye doctor. They do not understand the role I play in their care, until I explain their diagnosis and/or treatment plan. Furthermore, they will call me an optometrist or call the optometrist an ophthalmologist. Do optometrists run into this similar situation?

I have been called an ophthalmolgist and an optician many times. If they call me an ophthalmologist I always point out that I'm not an ophthalmolgist. I can not recall a single time in my entire career where I have not been able to handle the reason for the visit and after explaining that, patients are universally comfortable.

If someone calls me an optician, I rarely point out that I'm an optometrist. It's almost never being said with malice and to correct the patient would almost universally come off as rude.

IndianaOD and KHE, it seems like you essentially dismissed the entire report, or white paper. Did you (or other optometrists) agree with any of the sections? Comments on access, legislative activity and implications, or framework for consumer eye care decisions?

If there are other consumer, governmental, or professional society reports that you know about, I would love to read them.

Thanks for your input.

There is plenty of factual legitimacy in that report. My issue with it is that every time I have seen it cited by anyone, it has almost always been to use it to make the leap to some sort of illogical conclusion, as I mentioned above. eg. "Too much of the public thinks optometrists have medical degrees and they don't so they shouldn't be prescribing patanol."