The beginning of the end for the MD's

[GeddyLee]

So, now in OK, and OD can do the exact same scope of practice that and MD can. You have PA's expanding their scope and working independently in a number of specialties. Nurse anesthesists are filling the role of the anethesiologist. Why do you think all of this is happening? At this rate, your nice MD diploma will be practically worthless as all these pseudo-physicians greedily pluck away at what has traditionally been the territory of the MD.

And I do say GREEDILY. The culture of medicine has been to train properly to acquire the skill and licensure needed to increase your scope of practice. Not to go beg the government for a bill. A bill doesn't make you safe to practice. A bill does not replace medical school and residency. A bill only makes you legal, based on the number of people and amount of money you had backing the bill. To all of the GREEDY OD's, PAs, CRNP's, CRNA's.....you will never be the equivalent of an MD because someone signed their name to a piece of paper stating that you were.

The only way you can become that equivalent is to undergo the training. And being a nurse or a EMT for 20 years, although an impressive and noble feat, does not equate to medical school and residency. And certainly, being an OD with your 1 year of clinical experience and practice shooting laser at rabbit eyes does not make you qualified to go diggin around in a human eye with instruments that can destroy that eye.

In OK, is there now any need for OMD's? I think they should all pack up and leave the state. Protest! do something to show the idiots who run the OK legislature that OD does not equal OMD. OD's doing catataract surgery? this is truly a giant step for our health care system. Surely, if a similar bill came forth that gave PA's the right to perform laparascopic cholecystectomies and hernia repairs, the OK government would immediately sign it into law, right? Likely not, because they probably think that because OPH procedures are quick, they must be easy. Most legislators and politicians are truly idiots, go meet with one of your state legislators if you don't believe it. Especially if you live in a rural state. Of course they don't understand why it takes an MD to do surgery!!

Three years of optometry school + the 1 year of clinical experience? That's the typical OD school right? This gives your the training necessary to do enucleations?

Personally, I grieve for the poor Oklahomans that will no doubt have their eyes trashed by one of these pathetic OD's who had to use the law to to expand their expertise, rather than training. This will surely effect ophthalmologists too. The rate of failed cataracts will increase, prompting increased malpractice premiums. The reimbursements for these procedures will fall. And because the general public couldn't tell you the difference between an OMD and an OD, the practice of ocular surgery will be thrown backward 50 years as people assume it is pseudo-surgery.

Of course, you will all argue that with a little bit of training, the OD's will do just fine. With a little bit of training, I could command the space shuttle...that doesn't mean its either appropriate, or a good idea.

I really don't see the point of being an ophthalmologist in OK now. They must be livid, to have had their training suddenly equated to that of the OD with the swift stroke of a pen. A call to arms....OK OMD's protest!!!! Leave the State!!!! GO on STRIKE!!!!

Better yet, start a program of public education that will make the people aware of the difference in qualifications, so they can make their own choice about appropriate scope of practice.

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[DreamJob]

I am assuming that by MD you are referring to both MD's and DO's, because they obviously go through the same rigors. Besides that point I think you have a lot of truth in your post and I agree it is a crime not only for the physicians in the state of Oklahoma, but ESPCIALLY for the patients.

 

[GeddyLee]

Of course (sorry to overlook), I meant MD's and DO's. Honestly, with the gains that "allied" health providers are taking, the DO vs MD debate is quite ridiculous. MD's and DO's are completely equal in their qualifications to practice medicine.

 

[MPS]

There are antecedents to today?s struggles - medics have always had to fight against those who it claimed were un- or under-qualified. It is only in the last 150 years or so that medicine has come close to holding a monopoly. As I've said before, ophthalmology merely needs to promote itself and differentiate itself from optometry. Any publicity campaign will have to be conducted carefully - there is a risk or patronising the public, and of alienating many optometrists.

 

[Nilf]

With all due respect... I know next to nothing about opthalmology... but you seem to be making generalizations about all specialties, not only optho. You are deploring the fact, that these little peoples like CRNAs, ODs etc are taking over, GREEDILY, from MD (and DO), who are NEVER greedy, as we all know... lol... Consider this... Technology is changing... Client expectations are changing... What used to be cutting edge a decade ago, may not be so now... Why don't we let the market decide what kind of procedures can be performed only by MDs? I know what you will say... How can we endanger our patients with this laissez-faire attitude? But this has always been the case with medicine... Innovations become commonplace only if they can stand the test of time... Whether or not we're talking about work organization, or new technologies... Well you won't stop the stampede by 'protesting' new work policies, trying to have things run like in the good ole' days...

Let's wait and see... Maybe it's not such a bad idea that many procedures can be done by highly skilled non-MDs. I believe, that ultimately the market will determine who is right.

 

[Andrew_Doan]

Innovations become commonplace only if they can stand the test of time...

This is the fundamental flaw in your argument. You clearly do not understand the risks and benefits of surgical procedures.

No matter how "commonplace" a surgical procedure becomes, there will always be complications. Knowing when to cut and when to watch are just as important as knowing how to cut.

 

[GeddyLee]

Unfortunately, the "market" does not have a thorough understanding of medicine or surgical procedures. So when you let the market decide, it's probably the wrong decision. Of course people want cheaper health care, and easier access. But just because people want these things doesn't mean we should go running to grant increased scope of practice to anyone who asks for it.

 

[Andrew_Doan]

Unfortunately, the "market" does not have a thorough understanding of medicine or surgical procedures. So when you let the market decide, it's probably the wrong decision. Of course people want cheaper health care, and easier access. But just because people want these things doesn't mean we should go running to grant increased scope of practice to anyone who asks for it.

This is a good point. The "market" doesn't really understand what is required to practice ophthalmology. One of my wife's friends asked me, "So I hear you're going into ocular pathology. Does that mean you'll be dealing with more than just astigmatism?"

 

[Energon]

To be perfectly honest, physicians need to take a lesson from the dental community. They have been very good with protecting thier turf from allied health professionals. They have also dealt with the managed care industry better than their MD/DO counterparts. Here are some of the reasons why I think physicians are loosing a lot of ground:

1. Superiority Complex. Unfortunately, in the good ol days, once you slapped an MD or a DO at the end of your name you were God. This is not true today. As physicians, you have to realize that in order to survive and more importantly provide good care to patients, you have to fight tooth and nail against all those who want to undermine you: allied health professionals, policy makers and most of all the TLA.

2. Better organization and communication: The medical community has to organize itself a lot better. I was happy to see them go on strike in my state. They still did not get what they wanted but atleast they made a statement.

3. The medical community is too fractional: For some reason physicians have always been in a never ending pissing contest. The MD vs the DO, the specialist vs the primary care providers, specialst vs the other specialist, the surgeon vs the interventionist etc etc etc. STOP THAT.

Dr. Doan serves as the best example to us all. Very involved with up coming medical professionals, takes time out to give good advice, very willing to share information (and he has lot of it); most of all his involvement in the political aspect of medicine. This is a must for every practioner, be vocal about your field and be active politically.