Typical day for an optometrist who doesn't specialize?

[optEXTREME]

• What is a typical day like for an optometrist who doesn't have a particular specialization?

in terms of what a general practitioner does compared to someone who specializes in pediatrics, vision therapy...

is it just that a general practitioner does a little of everything..contact lens fitting, eye exams, etc. ? maybe it's the variety of patients is different for specialties??

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[Eyedoc1999]

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[mupreopt]

optEXTREME, are you asking what a "day in the life" for an optometrist is like?

 

[IndianaOD]

• What do you think a typical day is for an optometrist who doesn't have a particular specialization?

in terms of what a general practitioner does compared to someone who specializes in pediatrics, vision therapy...

is it just that a general practitioner does a little of everything..contact lens fitting, eye exams, etc. ? maybe it's the variety of patients is different for specialties??

Shadowing different ODs is the only way to answer this question.

 

[stonegoat]

IndianaOD is correct....shadowing is the best way to get an idea. However, I will give present and "average" day scenerio...

Start at 8:00 AM...see 15 patients before lunch, 9 of which are in for a "routine exam", 2 are cataract post-ops, 2 contact lens checks, and maybe 2 eye infections/foriegn body removal.

One hour lunch🙂

See 6 or seven patients in the afternoon...5 routine, 1 trichiasis epilation and 1 uveitis patient.

Of course this is just a scenerio...lots of variation from day to day exists.

I love my profession😀

 

[362.04]

optEXTREME,

In my hospital practice, I cover the hospital for 2 days a week. I will have 30-40 patients scheduled per day and will entertain between 5-10 emergency department referrals per day. Most of these referrals I will see and triage to one or more eye surgeons on their particular day.

At 8:00am, the clinic starts. I work aside dentistry, dermatology, ENT. Our waiting are is shared with outpatient departments of orthopedics, urology, general surgery, cosmetic surgery and neurosurgery. There may be 40-60 people in the waiting room at any one time.

I walk into the room with the patient's eyes already dilted and some pretesting done. If a language interpreter is needed, I will have one available right there or can have the line for one over the phone.

Every 10-15 minutes, I complete the patient and dictate my findings. I just sign the chart and don' t write anything down in the charte. Just my signature. Our dications go straight into the EMR of the hospital./

I write the lens or drug prescriptions and hand it to a nurse or medical assistant who discuss how to use the medication or the glasses. I'm off to the next patient.

When I extract rust rings or foreign bodies, a kit is already set up on the desk with 25 gauge needle, Alger brush, Cotton t ipped applicators, ointment, Lidocaine, proparacaine and rx pad for my 3 favorite meds for these cases.

At lunchtime, it's dictating or going to the doctor's lounge to meet with other doctors because I serve on 3 hosptial committees. In fact, I just received a 3 year grant for a study on diabetics for which the hospital is very happy to receive.

The afternoon is much like the morning and I finish charting or metting with committee members. I do have a practice outside the hospital, but it is composed mainly of "well eye" patients.


HTH

 

[mtrlOATgal]

wow that is such amazing work that you do in the hospital! I am from Canada so few optometrists work in the hospitals...

Could you tell me if you are working in a VA hospital? Do we get all that training with extracting foreign bodies in our OD training? How do we train on that? I would suppose with a fake model but... where would the practical training come from? I know OMDs take three years of training before they do any surgery.....

Thanks 🙂

btw as for ODs who do specialize, the OD whom I shadowed specializes in vision therapy but she sees other patients as well- from contact lens, evaluating if vision is fine for driving, trifocals, bifocals, children, geriatrics to treating patients who have a mental illness..... i think she saw about 8-10 patients a day bc she took her time to know her patients, understand their lifestyle and how it impacted their visual health

 

[drbizzaro]

optEXTREME,

In my hospital practice, I cover the hospital for 2 days a week. I will have 30-40 patients scheduled per day and will entertain between 5-10 emergency department referrals per day. Most of these referrals I will see and triage to one or more eye surgeons on their particular day.

At 8:00am, the clinic starts. I work aside dentistry, dermatology, ENT. Our waiting are is shared with outpatient departments of orthopedics, urology, general surgery, cosmetic surgery and neurosurgery. There may be 40-60 people in the waiting room at any one time.

I walk into the room with the patient's eyes already dilted and some pretesting done. If a language interpreter is needed, I will have one available right there or can have the line for one over the phone.

Every 10-15 minutes, I complete the patient and dictate my findings. I just sign the chart and don' t write anything down in the charte. Just my signature. Our dications go straight into the EMR of the hospital./

I write the lens or drug prescriptions and hand it to a nurse or medical assistant who discuss how to use the medication or the glasses. I'm off to the next patient.

When I extract rust rings or foreign bodies, a kit is already set up on the desk with 25 gauge needle, Alger brush, Cotton t ipped applicators, ointment, Lidocaine, proparacaine and rx pad for my 3 favorite meds for these cases.

At lunchtime, it's dictating or going to the doctor's lounge to meet with other doctors because I serve on 3 hosptial committees. In fact, I just received a 3 year grant for a study on diabetics for which the hospital is very happy to receive.

The afternoon is much like the morning and I finish charting or metting with committee members. I do have a practice outside the hospital, but it is composed mainly of "well eye" patients.


HTH

wow that sounds amazing! i would love to add that to my weekly schedule (i currently work corporate, but i'll be heading off soon)

in terms of FB removals: do you do all FB's regardless of corneal placement? ie. i've had some patients come in with FB's right in the center of the cornea with a fairly deep imbededness, and i send them off. In others, I have had no problems with the usage of needles and my alger brush. Do you think it's a bad call on my part to refer out central corneal FB's, or is it a smart decision?

Thanks

 

[Ben Chudner]

Do you think it's a bad call on my part to refer out central corneal FB's, or is it a smart decision?

If you don't feel comfortable removing central corneal FB's then you should refer. The question you should be asking is why don't you feel comfortable.

 

[EyeballerOD]

optEXTREME,

In my hospital practice, I cover the hospital for 2 days a week. I will have 30-40 patients scheduled per day and will entertain between 5-10 emergency department referrals per day. Most of these referrals I will see and triage to one or more eye surgeons on their particular day.

At 8:00am, the clinic starts. I work aside dentistry, dermatology, ENT. Our waiting are is shared with outpatient departments of orthopedics, urology, general surgery, cosmetic surgery and neurosurgery. There may be 40-60 people in the waiting room at any one time.

I walk into the room with the patient's eyes already dilted and some pretesting done. If a language interpreter is needed, I will have one available right there or can have the line for one over the phone.

Every 10-15 minutes, I complete the patient and dictate my findings. I just sign the chart and don' t write anything down in the charte. Just my signature. Our dications go straight into the EMR of the hospital./

I write the lens or drug prescriptions and hand it to a nurse or medical assistant who discuss how to use the medication or the glasses. I'm off to the next patient.

When I extract rust rings or foreign bodies, a kit is already set up on the desk with 25 gauge needle, Alger brush, Cotton t ipped applicators, ointment, Lidocaine, proparacaine and rx pad for my 3 favorite meds for these cases.

At lunchtime, it's dictating or going to the doctor's lounge to meet with other doctors because I serve on 3 hosptial committees. In fact, I just received a 3 year grant for a study on diabetics for which the hospital is very happy to receive.

The afternoon is much like the morning and I finish charting or metting with committee members. I do have a practice outside the hospital, but it is composed mainly of "well eye" patients.


HTH

362.04 - Mild nonproliferative diabetic retinopathy??

 

[drbizzaro]

If you don't feel comfortable removing central corneal FB's then you should refer. The question you should be asking is why don't you feel comfortable.

i only have a handful of FB removals under my belt. I have no problems doing FB removal, however, what I fear is the possibility of scarring with patients not using adequate drops after the FB removal (and therefore usually if the FB is fairly deep and central I refer out). This is what all my attendings used to tell my class. They used to tell us just to avoid all legal issues and refer out to stay safe.

 

[362.04]

This reflects one risk factor present anywhere in the retina of a diabetic.

 

[362.04]

I would try removing central or paracentral CFBs only if you have the requisite skill, experience, and follow up.

 

[362.04]

To mtrlOATgal,

I'm an "attending" at a local community hospital of about 250 beds.

 

[362.04]

'.....I have had no problems with the usage of needles and my alger brush. Do you think it's a bad call on my part to refer out central corneal FB's, or is it a smart decision?

Thanks

I'm unclear about your comfort level. The above excerpt is contradictory. Either you are comfortable or your not.

 

[IndianaOD]

i only have a handful of FB removals under my belt. I have no problems doing FB removal, however, what I fear is the possibility of scarring with patients not using adequate drops after the FB removal (and therefore usually if the FB is fairly deep and central I refer out). This is what all my attendings used to tell my class. They used to tell us just to avoid all legal issues and refer out to stay safe.

Why do you feel someone else will do a better job? PCPs and ER docs dig these things out without a slit lamp and next to no eye training.

ODs need to get over their senseless fears.

 

[Ben Chudner]

This is what all my attendings used to tell my class. They used to tell us just to avoid all legal issues and refer out to stay safe.

It's nice to see our schools are more concerned with teaching students how to "CYA" instead of how to become optometrists.🙄 Thank god you work in a commercial location Dr. Bizzaro where this refer everything mentality won't really affect your practice.

 

[stonegoat]

Wow..an optometrist that's afraid to remove a foriegn body...what year is it?? I have removed dozens of foriegn bodies from various locations. I had a patient who over-filled a tire which subsequently exploded in his face. He literally had dozens of imbeded particles of rock/sand within his corneas and conjunctiva. I spent over an hour and three visits picking out the rock. Fortunately he made an excellent recovery.

He never saw an ophthalmologist because he didn't need to. What would an OMD do that I didn't? Nothing.

 

[drbizzaro]

Wow..an optometrist that's afraid to remove a foriegn body...what year is it?? I have removed dozens of foriegn bodies from various locations. I had a patient who over-filled a tire which subsequently exploded in his face. He literally had dozens of imbeded particles of rock/sand within his corneas and conjunctiva. I spent over an hour and three visits picking out the rock. Fortunately he made an excellent recovery.

He never saw an ophthalmologist because he didn't need to. What would an OMD do that I didn't? Nothing.

ok, but what about fairly deeply embedded particles into the cornea? i guess, what i'm wondering is - after graduating from opt school, were you fairly confident in all FB removals? my opt school only had us do 1 FB simulation on a piece of jello in order to graduate.

 

[SightIsPrecious]

ok, but what about fairly deeply embedded particles into the cornea? i guess, what i'm wondering is - after graduating from opt school, were you fairly confident in all FB removals? my opt school only had us do 1 FB simulation on a piece of jello in order to graduate.

May I ask which school and what year?

 

[362.04]

ok, but what about fairly deeply embedded particles into the cornea? i guess, what i'm wondering is - after graduating from opt school, were you fairly confident in all FB removals? my opt school only had us do 1 FB simulation on a piece of jello in order to graduate.

A corneal foreign body that is more than half way of itself into the cornea, then I can see that it is pretty well embedded. Although not likely to perforate the cornea, you would have to debride significantly.

I have to say that if the foreign body is larger than 1-2 mm and it's deep, then it is likely to require an OR visit. I had the pleasure of being tutored a while back by my MD mentor who watched me pull a large 2mm square metal object out of the cornea which was half way in into the stroma. It had gone trought the eye lid (entry wound on the outer tarsal plate and exit wound on the palpebral side. Now that I needed someone to watch me.

By my life changing experience was aboard an aircraft carrier where on the first night out on fleet operations 3 sailors had large corneal foreign bodies. Had 10 degree list from the turning. Very rough for those chaps.

 

[Ben Chudner]

ok, but what about fairly deeply embedded particles into the cornea? i guess, what i'm wondering is - after graduating from opt school, were you fairly confident in all FB removals? my opt school only had us do 1 FB simulation on a piece of jello in order to graduate.

Yes, after optometry school I was very confident in all FB removals. Between the one or two that came into the clinic at school and the 20 or 30 that I saw on rotations, I was ready. The current level of education at our schools makes me ill.

 

[IndianaOD]

I agree,

I removed several foreign bodies 1/2 to 2/3 the way through the cornea on my externships.

This is a reason I believe that a 5th year residency should be mandatory. To the poster above, why does it require an OR visit. If the globe is not penetrated you don't need help from no one 😀.

 

[362.04]

I agree,

I removed several foreign bodies 1/2 to 2/3 the way through the cornea on my externships.

This is a reason I believe that a 5th year residency should be mandatory. To the poster above, why does it require an OR visit. If the globe is not penetrated you don't need help from no one 😀.

An OR is recommended if the wound site is wide open and an expulsion or penetration is possible. When you have a large (!) 1- 2 mm square metallic foreign body, you might even need Xray or CT to rule out other fragments. It didn't get into the eye unless there was a high velocity ballistic injury. I Read again and I said it penetrated the closed eye lid completely like it was butter. 'm very suspicious of high velocity ballistic injuries to the eye or cornea.

 

[mtrlOATgal]

To all practicing optometrists on this thread/forum,

Is there an externship ( VAs, hospitals, specific areas?) that you would recommend students to apply for that will give us the maximal surgical exposure that an optometrist may face if working in a hospital?

 

[362.04]

To all practicing optometrists on this thread/forum,

Is there an externship ( VAs, hospitals, specific areas?) that you would recommend students to apply for that will give us the maximal surgical exposure that an optometrist may face if working in a hospital?

Before this question can be answered, are you inferring about observing major incisional surgery or performing superficial surgical procedures?

 

[IndianaOD]

Externships vary by school. You can only attend certain ones if you attend certain schools. You should talk to fourth years or recent grads who have been to the sites.

I really liked Huntington WV VA for what its worth.

 

[mtrlOATgal]

thanks for your response.

Sorry, I am not in optometry school so I honestly cannot differentiate the surgeries.

Does malpractice insurance increase if you do surgery?

 

[Senorwes1]

Why is everybody attacking this OD for referring a pt out? In some states, OD's are only allowed to do certain types of FB removals. Also, it depends on how long the FB has been there. If it has been more than 48 hours, usually the pt. will need to have it removed surgically. People are also very "sue" happy and would love to make a few bucks off of an OD. Let the MD do it... who cares?

 

[362.04]

Why is everybody attacking this OD for referring a pt out? In some states, OD's are only allowed to do certain types of FB removals. Also, it depends on how long the FB has been there. If it has been more than 48 hours, usually the pt. will need to have it removed surgically. People are also very "sue" happy and would love to make a few bucks off of an OD. Let the MD do it... who cares?

Thank you senorwes1 for your post. Actually, a foreign body in the cornea only erodes the cornea with a rust ring. I've taken CFBs out that have been retained for 2 weeks.

What kind of optometry do you plan to practice?

 

[drbizzaro]

Why is everybody attacking this OD for referring a pt out? In some states, OD's are only allowed to do certain types of FB removals. Also, it depends on how long the FB has been there. If it has been more than 48 hours, usually the pt. will need to have it removed surgically. People are also very "sue" happy and would love to make a few bucks off of an OD. Let the MD do it... who cares?

that is what a lot of my former professors kept insinuating: the fact that people will sue you over the smallest mishap (ie. if there is any residual scarring of corneal tissue after corneal FB removal)

 

[362.04]

Interesting comments from both spectrums of the profession (one who is in school and one who is out of school)

I think no one should pursue or perform any procedure or see any patient that would make themselves uncomfortable, but it is incumbent to refer patients to a professional who would most likely benefit the patient.

One of the longstanding precepts I have preached to medical authorities is the availability, accessibility and ability of optometrists who do h ave this kind of training and expertise and who can perform them on patients with outcomes equivalent to almost any ophthalmic surgeon. And they can probably do it less expensively by 50-75% probably.

One of the additional precepts I have found is the approach to most patients. Most patients who sue will do so because the doctor is discourteous, disrespectful or dismissive of the patient. In other words, you would not even want to sit next to them on a coffee bar stool.

If you act like a butthead, then of course, you will certainly be sued for anything and everything. But being a good guy means a lot and in some circumstances, might make you less defensive than otherwise.

 

[coppertopdoc]

Most patients who sue will do so because the doctor is discourteous, disrespectful or dismissive of the patient. In other words, you would not even want to sit next to them on a coffee bar stool.

If you act like a butthead, then of course, you will certainly be sued for anything and everything. But being a good guy means a lot and in some circumstances, might make you less defensive than otherwise.

I agree wholeheartedly! I have practiced in ophthalmology or Indian Health Service settings most of my career. I have been involved in cases that got ugly and could have even been a lawsuit waiting to happen.

There were several things that made the situation manageable. The first is patient education. You must inform them about potential complications, i.e. scarring from FB removal. The second is to show genuine compassion and bend over backwards to help the patient deal with whatever has happened. The third is to keep that line of communication open so that the patient can call you if concerned.

I feel if you approach any difficult patient situation in that manner, then you usually have a very grateful patient who knows that you did everything you could to help. That will help you avoid a lawsuit.

 

[Ben Chudner]

And they can probably do it less expensively by 50-75% probably.

I agree with everything you said in your post except for this statement. Why would you feel that OD's can do it less expensively by 50-75%? For private pay patients that see a private practice OD, there might be a difference in the amount billed, but I doubt it would be 50%. In a commercial practice maybe, but I really don't know what Wal-Mart docs charge for FB removal. If the patient has insurance, most likely there would be no difference in cost since OD's are reimbursed the same as MD's (as long as our fees are at least equal to the insurance allowable).

 

[362.04]

I agree with everything you said in your post except for this statement. Why would you feel that OD's can do it less expensively by 50-75%? For private pay patients that see a private practice OD, there might be a difference in the amount billed, but I doubt it would be 50%. In a commercial practice maybe, but I really don't know what Wal-Mart docs charge for FB removal. If the patient has insurance, most likely there would be no difference in cost since OD's are reimbursed the same as MD's (as long as our fees are at least equal to the insurance allowable).

I was basing this upon capitated or managed care perspectives. I think the advantage of optometry is their cost effectiveness as compared to ophthalmologist.

Let's say that a salaried ophthalmologist in a managed care program starts out at 160-180k. An OD would probably cost the plan between 80-120K.

 

[IndianaOD]

Why is everybody attacking this OD for referring a pt out? In some states, OD's are only allowed to do certain types of FB removals. Also, it depends on how long the FB has been there. If it has been more than 48 hours, usually the pt. will need to have it removed surgically. People are also very "sue" happy and would love to make a few bucks off of an OD. Let the MD do it... who cares?

I care because we are trained to take care of this stuff. Punting every time something besides myopia comes up is not only ridiculous but it makes people think ODs can't do anything but glasses or contacts. Take care of your patients. They should only be refered out for intra-ocular surgery.

 

[Ben Chudner]

I care because we are trained to take care of this stuff. Punting every time something besides myopia comes up is not only ridiculous but it makes people think ODs can't do anything but glasses or contacts. Take care of your patients. They should only be refered out for intra-ocular surgery.

My concern is that the instructors at our optometry schools are recommending that patients be referred out to minimize liability. I completely agree that if a doctor does not feel comfortable with treating a patient, for whatever reason, that patient should be referred. If that is what bizarro was taught I would have no issue, but what he said was that his instructors taught him to refer central corneal foreign bodies because they are too risky for an OD to remove. Where do we draw the line as to what's too risky to treat? Glaucoma is sight threatening. Should we refrain from treating it because the patient could go blind and sue? If this is what the optometry schools are teaching, it appears they are preparing our future OD's to work in an optical shop (private or commercial) where there only thing they are comfortable treating is refractive error. I am not saying that OD's should treat anything outside their scope of practice, and those of you that have read my posts should know that I am not an advocate for non-laser surgical rights for OD's, but I do expect OD's to be trained and to treat to the full extent of our scope of practice.

 

[IndianaOD]

My concern is that the instructors at our optometry schools are recommending that patients be referred out to minimize liability. I completely agree that if a doctor does not feel comfortable with treating a patient, for whatever reason, that patient should be referred. If that is what bizarro was taught I would have no issue, but what he said was that his instructors taught him to refer central corneal foreign bodies because they are too risky for an OD to remove. Where do we draw the line as to what's too risky to treat? Glaucoma is sight threatening. Should we refrain from treating it because the patient could go blind and sue? If this is what the optometry schools are teaching, it appears they are preparing our future OD's to work in an optical shop (private or commercial) where there only thing they are comfortable treating is refractive error. I am not saying that OD's should treat anything outside their scope of practice, and those of you that have read my posts should know that I am not an advocate for non-laser surgical rights for OD's, but I do expect OD's to be trained and to treat to the full extent of our scope of practice.

I completely agree. Lasers and intraocular injections should be within our scope. Cataracts, trabs, strabs, and vitrectomy not so much.

 

[362.04]

Some may wonder what it is like to be an associate staff member of a hospital of about 250 beds.

There are meetings and there are meetings. Generally, hospitals have dual lines of authority. One half, let us say, is composed of all of the medical staff which means physicians and other licensed professionals. The other half is the administrative side of which includes clerical staff, medical assistants, medical records, housekeeping, etc. Both sides are needed.

The medical staff is usually headed by the chief of staff and is ably assisted by chiefs of service. The administrative staff is usually headed by the President or Chief Executive Officer. The Chief of Staff usually h as a direct line to the CEO.

Well, I'm part of both because practically all medical staff will one way or another will have committee assignments. These may cover things as mundane as adjudicating the appropriate medical abbreviations that are acceptable in either written or electronic charts to evaluating digital dictation and transcription to electronic medical records.

These assignments are voluntary and are unpaid and often are required as part of membership of the hospital. I am on 4 committees and occupy fully almost 8-10 hours per week. Meetings will usually occur over the lunch hour or first thing in the morning. And when JCAHO or Medicare notices you for an audit, the hours increase.

Just a thought.

 

[hawkster]

Very interesting posts but I don't think they answered your question. I practice in a similar manner as 362.04 but not in a hospital setting and I would say that it is atypical of the average optometrist. I love ocular disease and I am practicing similar to how I had envisioned prior to entering optometry school. I did however practice in a more typical setting for several years before I lucked out. I would say a typical day would entail 10-15 routine exams including contact lens fittings/followups. 1-4 urgent/medical visits (sometimes none). Please shadow more than one optometrist to get feeling for what a typical day is like. The time will be well spent. I wish I had done the same. Good luck.