Turf War Question From a Psychiatry Resident

[PsychMD2100]

Greetings Ophthalmologists,

I normally post over on the Psychiatry forum. I am a Psychiatry resident and we've been having discussions about how some Clinical Psychologists (PhDs) and Licensed Clinical Social Workers (LCSWs) have impacted our practice. In some severely underserved jurisdictions (ie New Mexico), Clinical Psychologists have been granted the ability to prescribe psych meds. LCSWs are now doing psychotherapy since managed care has pushed Psychiatrists into doing the things that make them unique, eg ECT, involuntary commitment, and psych meds.

I'm posting similar questions in other forums, but I wanted to ask them here:

How have your turf wars with Optometrists changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)?

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[IndianaOD]

Greetings Ophthalmologists,

I normally post over on the Psychiatry forum. I am a Psychiatry resident and we've been having discussions about how some Clinical Psychologists (PhDs) and Licensed Clinical Social Workers (LCSWs) have impacted our practice. In some severely underserved jurisdictions (ie New Mexico), Clinical Psychologists have been granted the ability to prescribe psych meds. LCSWs are now doing psychotherapy since managed care has pushed Psychiatrists into doing the things that make them unique, eg ECT, involuntary commitment, and psych meds.

I'm posting similar questions in other forums, but I wanted to ask them here:

How have your turf wars with Optometrists changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)?

My guess is that this thread is about 2 posts away from being shut down. If you are that worried about this then perhaps you have chosen the wrong path. There is still time to change. If someone has the training and education why are they not allowed to practice up to their full potential? Just so you can become rich?

Since a PhD has much more training in psychotherapy should they be the only ones allowed to do it? Why should you be allowed to do it?

 

[DiveMD]

My guess is that this thread is about 2 posts away from being shut down. If you are that worried about this then perhaps you have chosen the wrong path. There is still time to change. If someone has the training and education why are they not allowed to practice up to their full potential? Just so you can become rich?

Since a PhD has much more training in psychotherapy should they be the only ones allowed to do it? Why should you be allowed to do it?

TROLL!!!!!

 

[Mirror Form]

TROLL!!!!!

Sadly, this is an honest representation of what many OD's have been brainwashed into thinking. It's ironic that they claim it's the "MD's" who're just trying to hold turf for money, when they're motiviation is purely based on cash w/o regard to patient safety.

 

[KHE]

And they're off!!

Out of the gate its Optometrists Doing Surgery! Optometrists Doing Surgery starts out strong followed closely behind by Yea So What and We're Qualified Anyways. We're Qualified Anyways moves up on the inside along with I Took The Same Anatomy Class as Med Students and Only MDs Should Do Surgery! As they come to the clubhouse turn it's My GPAs Higher than Yours on the outside followed by I Took the MCATs! I Took the MCATs is packed in tight with Yea So What and Go To Med School! As they come down the far stretch Go To Med School falls back! At the head of the pack, it's I Knew A Guy Who Went to an OD Once and Now He's Blind both making their moves! It's an INCREDIBLE race folks! I don't believe it! Out of NOWHERE comes Dentists Do Surgery and Go To Med School! Go To Med School ROARS back into the race!! It's Dentists Do Surgery, it's Go To Med School! It's Dentists Do Surgery, it's Go To Med School NECK AND NECK!

As they round the far turn, Working Together is NO WHERE IN SIGHT! Working Together is dead last! Still up at the front its Dentists Do Surgery and Go To Med School but here comes I Didn't Want to Go To Med School and PIs are Easy making a hard charge! PIs are Easy is making his move to the inside trying to squeeze by ODs Are Greedy and Patients Will Go Blind and DOWN THE STRETCH THEY COME! The crowd is going wild!

As they come down the stretch it's still a dead heat between Dentists Do Surgery and Go To Med School! Only MDs Should Do Surgery is pouring it on at the end along with PIs ar Easy and as they come to the finish line it's....IT'S.......IT'S More Wasted Bandwidth BY A NOSE!!!

I don't belive it folks! I've never seen a race like it! WOW!

3-5-9 Trifecta pays $129.12.

 

[jefguth]

So, ignoring all the above, no one wants to answer the OP's question?

How have your turf wars with Optometrists changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)?

 

[Eyescan]

I have no direct turf battles with optometrists at the moment. I had some contact with them during training. I get referrals from them and I refer to them.

Whenever you have a gatekeeper, be it social workers doing psychotherapy or optometrist being the gatekeeper for eye probems, you are going to have some people who could have received better treatment from the expert.

Some pharmacies (perhaps CVS and Wal Mart) are planning to set up clinics run by non-MD's to treat sore throats and red eyes. Not all red eyes are conjunctivitis. This hurts optometrists! They need to fight that!

 

[Visionary]

And they're off!!

Out of the gate its Optometrists Doing Surgery! Optometrists Doing Surgery starts out strong followed closely behind by Yea So What and We're Qualified Anyways. We're Qualified Anyways moves up on the inside along with I Took The Same Anatomy Class as Med Students and Only MDs Should Do Surgery! As they come to the clubhouse turn it's My GPAs Higher than Yours on the outside followed by I Took the MCATs! I Took the MCATs is packed in tight with Yea So What and Go To Med School! As they come down the far stretch Go To Med School falls back! At the head of the pack, it's I Knew A Guy Who Went to an OD Once and Now He's Blind both making their moves! It's an INCREDIBLE race folks! I don't believe it! Out of NOWHERE comes Dentists Do Surgery and Go To Med School! Go To Med School ROARS back into the race!! It's Dentists Do Surgery, it's Go To Med School! It's Dentists Do Surgery, it's Go To Med School NECK AND NECK!

As they round the far turn, Working Together is NO WHERE IN SIGHT! Working Together is dead last! Still up at the front its Dentists Do Surgery and Go To Med School but here comes I Didn't Want to Go To Med School and PIs are Easy making a hard charge! PIs are Easy is making his move to the inside trying to squeeze by ODs Are Greedy and Patients Will Go Blind and DOWN THE STRETCH THEY COME! The crowd is going wild!

As they come down the stretch it's still a dead heat between Dentists Do Surgery and Go To Med School! Only MDs Should Do Surgery is pouring it on at the end along with PIs ar Easy and as they come to the finish line it's....IT'S.......IT'S More Wasted Bandwidth BY A NOSE!!!

I don't belive it folks! I've never seen a race like it! WOW!

3-5-9 Trifecta pays $129.12.

I gotta say that was darn funny. I'm going to go change my shorts now.

 

[rubensan]

Greetings Ophthalmologists,

I normally post over on the Psychiatry forum. I am a Psychiatry resident and we've been having discussions about how some Clinical Psychologists (PhDs) and Licensed Clinical Social Workers (LCSWs) have impacted our practice. In some severely underserved jurisdictions (ie New Mexico), Clinical Psychologists have been granted the ability to prescribe psych meds. LCSWs are now doing psychotherapy since managed care has pushed Psychiatrists into doing the things that make them unique, eg ECT, involuntary commitment, and psych meds.

I'm posting similar questions in other forums, but I wanted to ask them here:

How have your turf wars with Optometrists changed the way you practice? Are there concrete examples of how they have undermined your practice (ie decreased salary, decreased patient volume)?

Please keep in mind that most of the feeback on this forum that you will receive on this subject will be from medical students, ophthalmologists in training and our usual company of optometry guests. From my perspective, very few of us here have the experience of being in private practice long enough to answer how all of this will play out. I am sure you will receive strong opinions from both sides.

 

[hello07]

As an optometrist, I cannot speak for the majority but in my opinion optometrists have not undermined the practices of successful ophthalmologists. Especially the ones who have been around for a while. In NYC, we are not a threat to them in any manner. Anything we can treat topically and feel confident we do it. Otherwise, the majority of times those working in retail and private practice refer out.
in my opinion, OMD are not threatened nor do they feel threatened by us. Salaries, reimburesements/ cuts across the board is another issue not set by us but by the government and insurance companies.
If I was an ophthalmologists, I wouldn't be concerned with optometrists affecting my income or practice. My 2 cents.

 

[PDT4CNV]

As an optometrist, I cannot speak for the majority but in my opinion optometrists have not undermined the practices of successful ophthalmologists. Especially the ones who have been around for a while. In NYC, we are not a threat to them in any manner. Anything we can treat topically and feel confident we do it. Otherwise, the majority of times those working in retail and private practice refer out.
in my opinion, OMD are not threatened nor do they feel threatened by us. Salaries, reimburesements/ cuts across the board is another issue not set by us but by the government and insurance companies.
If I was an ophthalmologists, I wouldn't be concerned with optometrists affecting my income or practice. My 2 cents.

The turf war is in the mind of a few optometrist. In reality, 99% of optometrists out there don't treat much beyond ametropia and "conjunctivitis". Some try to treat open angle glaucoma. The only threat is in the rhetoric that some OD's use to try to convince people of their importance and "qualifications". At this point, optometrist have no influence on our practice.

Believe me, psych PhD's are really no threat to you. They are not clinicians. Reading a few textbooks and then doing a series of small ridiculous studies on undergrads (does some college kids pulse and respiratory rate go up when he touches the back of tarantula) for 4-5 years does not a physician make. The only threat is in their ability to influence government, and government is not interested in qualifications or right and wrong, but in compromise.

 

[fjpod]

Sadly, this is an honest representation of what many OD's have been brainwashed into thinking. It's ironic that they claim it's the "MD's" who're just trying to hold turf for money, when they're motiviation is purely based on cash w/o regard to patient safety.

Did I read the same post you did? The original poster's question WAS based solely on turf protection for the sake of his practice and the economic impact on his pocketbook. He never mentioned any concern for effect on quality of patient care.

Go 'head. Fire away. I can take it.

 

[Mirror Form]

Did I read the same post you did? The original poster's question WAS based solely on turf protection for the sake of his practice and the economic impact on his pocketbook. He never mentioned any concern for effect on quality of patient care.

Go 'head. Fire away. I can take it.

LOL, and how does that contradict what I posted?

 

[KHE]

Sadly, this is an honest representation of what many OD's have been brainwashed into thinking. It's ironic that they claim it's the "MD's" who're just trying to hold turf for money, when they're motiviation is purely based on cash w/o regard to patient safety.

Oh, it's defiantely based on cash....no doubt about it.

But contrary to what you are probably thinking, it's not the "cash" that would come from the ability to do a few YAGs here and there or even a few LASIKs or PRKs. Especially since most ODs understand enough about economics to know that if you triple the supply of providers for a procedure overnight while leaving the demand the same, reimbursements and or fees will crash through the floor. No one wants to look back on the days of the $299 per eye LASIK billboard as the "golden years" of refractive surgery.

While there might be a few ODs out there that secretly harbor some deep desire to pretend that they're Jedi Knights and play with lasers, none of this is, at its core really about YAGs, or PIs, or LASIK, or chalazion removals.

It is really about who is going to ultimately have control over the profession known as optometry. Everytime some new eyedrop comes on the market, is optometry going to have to grovel before the medical boards of all 50 states to be able to use new therapies? Everytime some new treatment modality comes out for some common eye condition, is optometry going to have to seek medicine's blessing to use it?

That's really what it's about.

 

[Cirrus83]

best...post...ever...

Seriously, that just about sums up like half the allo and subspecialty forum threads.

And they're off!!

Out of the gate its Optometrists Doing Surgery! Optometrists Doing Surgery starts out strong followed closely behind by Yea So What and We're Qualified Anyways. We're Qualified Anyways moves up on the inside along with I Took The Same Anatomy Class as Med Students and Only MDs Should Do Surgery! As they come to the clubhouse turn it's My GPAs Higher than Yours on the outside followed by I Took the MCATs! I Took the MCATs is packed in tight with Yea So What and Go To Med School! As they come down the far stretch Go To Med School falls back! At the head of the pack, it's I Knew A Guy Who Went to an OD Once and Now He's Blind both making their moves! It's an INCREDIBLE race folks! I don't believe it! Out of NOWHERE comes Dentists Do Surgery and Go To Med School! Go To Med School ROARS back into the race!! It's Dentists Do Surgery, it's Go To Med School! It's Dentists Do Surgery, it's Go To Med School NECK AND NECK!

As they round the far turn, Working Together is NO WHERE IN SIGHT! Working Together is dead last! Still up at the front its Dentists Do Surgery and Go To Med School but here comes I Didn't Want to Go To Med School and PIs are Easy making a hard charge! PIs are Easy is making his move to the inside trying to squeeze by ODs Are Greedy and Patients Will Go Blind and DOWN THE STRETCH THEY COME! The crowd is going wild!

As they come down the stretch it's still a dead heat between Dentists Do Surgery and Go To Med School! Only MDs Should Do Surgery is pouring it on at the end along with PIs ar Easy and as they come to the finish line it's....IT'S.......IT'S More Wasted Bandwidth BY A NOSE!!!

I don't belive it folks! I've never seen a race like it! WOW!

3-5-9 Trifecta pays $129.12.

 

[Therapist4Chnge]

The turf war is in the mind of a few optometrist. In reality, 99% of optometrists out there don't treat much beyond ametropia and "conjunctivitis". Some try to treat open angle glaucoma. The only threat is in the rhetoric that some OD's use to try to convince people of their importance and "qualifications". At this point, optometrist have no influence on our practice.

Believe me, psych PhD's are really no threat to you. They are not clinicians. Reading a few textbooks and then doing a series of small ridiculous studies on undergrads (does some college kids pulse and respiratory rate go up when he touches the back of tarantula) for 4-5 years does not a physician make. The only threat is in their ability to influence government, and government is not interested in qualifications or right and wrong, but in compromise.

*mod note*

This kind of stuff won't be tolerated on the forum; please keep it civil.

-t

 

[IndianaOD]

Sadly, this is an honest representation of what many OD's have been brainwashed into thinking. It's ironic that they claim it's the "MD's" who're just trying to hold turf for money, when they're motiviation is purely based on cash w/o regard to patient safety.

Several ophthalmology posters in this very forum have admitted its all about the money. There is no other legitimate reason. The safety profiles of ODs is spotless in scope expansion. "Patient safety" is a smokescreen and just sounds better.

To our OP, what about family docs and GP Rx'ing psychotics? Some pass it out like candy. Are they more qualified than PsyD's and Ph.Ds? Unfortunately managed care dictates than most Psychiatrists are pill-pushers. If that is what you are going to do then fine, just offer them a referall to someone who will offer CBT or something else. If you discredit these services you are doing a dis-service to your patients.

Just how some Ophthalmologists tell their patients that Vision Therapy is just smoke and mirrors. The research is overwhelmingly supporting the effectiveness of vision therapy, just as it shows counseling is as effective if not more than psychotropics for many conditions.

See Convergence insufficiency treatment trials (CITT) by PEDIG.

 

[PDT4CNV]

Several ophthalmology posters in this very forum have admitted its all about the money. There is no other legitimate reason. The safety profiles of ODs is spotless in scope expansion. "Patient safety" is a smokescreen and just sounds better.

To our OP, what about family docs and GP Rx'ing psychotics? Some pass it out like candy. Are they more qualified than PsyD's and Ph.Ds? Unfortunately managed care dictates than most Psychiatrists are pill-pushers. If that is what you are going to do then fine, just offer them a referall to someone who will offer CBT or something else. If you discredit these services you are doing a dis-service to your patients.

Just how some Ophthalmologists tell their patients that Vision Therapy is just smoke and mirrors. The research is overwhelmingly supporting the effectiveness of vision therapy, just as it shows counseling is as effective if not more than psychotropics for many conditions.

See Convergence insufficiency treatment trials (CITT) by PEDIG.

All about money...
Spotless safety record..
Smoke and mirrors..

Sorry, but your warped perception of things wont find much agreement in this forum.

 

[IndianaOD]

All about money...
Spotless safety record..
Smoke and mirrors..

Sorry, but your warped perception of things wont find much agreement in this forum.

Can't say I care too much. Look at the facts. If you have proof otherwise then I respect that but its not there. The truth doesn't need agreement. Oh BTW its a given that OMDs and ODs cross shop the forums.

 

[PDT4CNV]

Can't say I care too much. Look at the facts. If you have proof otherwise then I respect that but its not there. The truth doesn't need agreement. Oh BTW its a given that OMDs and ODs cross shop the forums.

What facts? What truth?

 

[eyerish]

I feel compelled to respond purely for the continued purity of discussion:

>The safety profiles of ODs is spotless in scope expansion.

Reference this please? And please be very precise in the definition of "safety profile" regarding the specific actions you refer to?

>To our OP, what about family docs and GP Rx'ing psychotics?

I'm assuming you mean anti-psychotics, considering the meds above might produce some rather undesirable results. I don't see the problem with this? It is a rare GP that prescribes anti-psychotics without consultation or ongoing follow up with psychiatric care.

>Some pass it out like candy.

Reference please? This sounds a bit like an incendiary "sound bite" to me.

>Are they more qualified than PsyD's and Ph.Ds?

More qualified to do what? Diagnose, treat, and prescribe medications for the treatment of psychiatric disorders? For the most part, yes. We worked closely with our PhD's during my rotations, and amicably at that. I do think there is often a very different "approach" to diagnosis and management, but more from a methodology standpoint.

>Unfortunately managed care dictates than most Psychiatrists are pill-pushers.

I'm not sure I understand this statement, nor do I feel it to be true. If you are one who wishes to expand your scope of prescribing abilities, why would you want to be calling others "pill pushers"? It tends to sound like you would also like to "push more pills" (or drops).

I agree with the sentiments of some of the above posts in that many of the responses found within are heavily weighted towards those still in school or ongoing training (myself included) though I believe the more you are involved with lobbying and private practices you will find varying views on the projected impact within your field. I'd be curious as to how you feel as your training / practice exposure progresses.

 

[IndianaOD]

I feel compelled to respond purely for the continued purity of discussion:
Reference this please? And please be very precise in the definition of "safety profile" regarding the specific actions you refer to?

I'm assuming you mean anti-psychotics, considering the meds above might produce some rather undesirable results. I don't see the problem with this? It is a rare GP that prescribes anti-psychotics without consultation or ongoing follow up with psychiatric care.
Reference please? This sounds a bit like an incendiary "sound bite" to me.

More qualified to do what? Diagnose, treat, and prescribe medications for the treatment of psychiatric disorders? For the most part, yes. We worked closely with our PhD's during my rotations, and amicably at that. I do think there is often a very different "approach" to diagnosis and management, but more from a methodology standpoint.

I'm not sure I understand this statement, nor do I feel it to be true. If you are one who wishes to expand your scope of prescribing abilities, why would you want to be calling others "pill pushers"? It tends to sound like you would also like to "push more pills" (or drops).

I agree with the sentiments of some of the above posts in that many of the responses found within are heavily weighted towards those still in school or ongoing training (myself included) though I believe the more you are involved with lobbying and private practices you will find varying views on the projected impact within your field. I'd be curious as to how you feel as your training / practice exposure progresses.

I will try to find you some references, but with a new family and growing practice I can't promise anything real soon. I'll find it. There is lots of data from when theraputics rights were being gained. Also the VA ODs who where doing some laser procedures had similar or less complications than ophthalmology.

On the flip side of the coin I'd like to see evidence that the public has been put into danger. In one of my old posts that's probably gone I showed a comparison between med school and optometry. Optometry has more pharm hours on average.

I really don't have anything against ophthalmology, just militant ophthalmologists. Just because you don't understand optometric training doesn't mean you should slander the profession. There are tons of crappy ODs and OMDs out there. I utilize evidence based medicine to take care of my patients. If there is solid evidence that optometric vision therapy is better for a given condition I do it. If research shows that surgery is more beneficial I send them on.

Ophthalmology, as most med students envison it, (lots of sexy surgery where all the big bucks roll in) could not exist without optometry. You can't be a good surgeon if you spend 90% of your time doing primary eye care.

I have to say it again, its all about the money. Medicine never has a problem with dentristry or podiatry because they don't do procedures MDs do.

 

[VA Hopeful Dr]

On the flip side of the coin I'd like to see evidence that the public has been put into danger. In one of my old posts that's probably gone I showed a comparison between med school and optometry. Optometry has more pharm hours on average.

Yes but med students have more clinical hours than OD students which I think more than makes up the difference.

I have to say it again, its all about the money. Medicine never has a problem with dentristry or podiatry because they don't do procedures MDs do.

I beg to differ. The ENT's get a touch antsy about the OMFS folks, and lots of the ortho's dislike any podiatrist that goes above the foot (such as ankle work).

Let it go man, no one is going to have their mind changed by anyone else here at this point. In fact, I think this thread was rather positive - most of the early posts were by MDs saying that they have no problem with ODs. But you bickering back and forth doesn't help or look good for the profession.

 

[IndianaOD]

Ahh its more interesting though. The optometry forums are pretty boring right now. My intention is not to persuade any OMDs for the militant ones are indoctrinated during their residencies/fellowships and are unable to think on their own. This is usually from older OMDs who still think Optometry is a 2 year degree.

I was feeling pretty good about the OMD/OD relationship until a couple of OMDs stabbed optometry in the back a few months ago in my home state. That's okay, those OMDs are loosing a ton of referrals.

 

[Mye Eye]

"My intention is not to persuade any OMDs for the militant ones are indoctrinated during their residencies/fellowships and are unable to think on their own."

How dare you sir...that is not only rude...but simply ridiculous

those people fortunate enough to train in Ophthalmology in the US are at the top of their medical schools....and therefore, able to intelligently think for themselves

please watch your words...you wont win any friends by implying OMDs are too stupid to think for themselves

 

[IndianaOD]

"My intention is not to persuade any OMDs for the militant ones are indoctrinated during their residencies/fellowships and are unable to think on their own."

How dare you sir...that is not only rude...but simply ridiculous

those people fortunate enough to train in Ophthalmology in the US are at the top of their medical schools....and therefore, able to intelligently think for themselves

please watch your words...you wont win any friends by implying OMDs are too stupid to think for themselves

Ahh you can be smart and brainwashed at the same time. You can be book smart and completely lack common sense. My optometry class had quite a few 4.0's from competitive undergrads, so what?

Is it smart to completely dismiss optometric vision therapy only to backpeddle when gold standard clinical trials prove its more effective than anything else?

You can absolutely be smart and still be wrongly influenced by those who you "look up to."

I've worked with quite a few OMD residents and fellows. You can always tell wich ones studied under a militant OMD instructor.