See, I strongly disagree with that. I can understand why you might feel that way given that you're still in school, and I'm sure the school has got you all revved up but a few points here:
1) Scope of practice makes not a lick of difference in the long term success of optometry. I have gone over that dozens of times. You can be trained up the wazoo and have the widest scope of practice possible, but if you can't get paid for it, it is of absolutely zero value to the profession. "All informed optometry faithfuls" should know that the success of optometry has almost nothing to do with scope of practice.
2) I also don't agree that putting heavy value on disease and medical related courses is good for the long term viability of the profession. Am I saying that ODs shouldn't be prescribing pataday, or managing glaucoma? No....of course not. But it's time for a reality check. Doing more and more disease management sounds fun and sexy and "doctorly" but the reality of it is is that you're talking about essentially duplicating services with ophthalmology. Considering that there is no access problem with respect to ophthalmological care, it makes little sense for ODs to move aggressively into this area, not because we "can't" or would be incompetent at it, but because it makes no economic sense to do so. The future success of optometry is not linked to us being more "like them."
3) Also understand that once you get outside of your academid cocoon, 90% of your patients are going to seek your advise for vision and refractive care, not for disease management. I own a private practice that is about as "medical" as an optometric practice can get and I would say that it's about 10-15% of my patients who present for "medical management" of some sort. Their entering complaint is almost universally vision or refractive in nature.
Again, this is an unwise move. More disease management simply makes us more "like them" and no matter what happens, optometry is always going to be regarded as 2nd class citizens in that arena. There is little that can be done about that so what we should be doing is accentuating our strengths.
Sadly, most of those people are ivory tower academics or people who work in tertiary referal centers. The majority of them have no clue that goes on in 95% of optometry out "on the street." Most of them have never had to make a payroll, or deal with lab vendors. Most of them have never had to hire or fire staff. Most of them have never had to chase down denied insurance claims. Most of them have never had to get an office off the ground, and keep it off the ground. As such, they essentially don't know schitt from shine-ola about what the profession needs to keep it viable.
And please don't take this as a personal attack. I understand where you're coming from and believe me, I've been there too. But the reality of it all will hit you soon enough. Hopefully not too hard. 😉
I guess I will add my perspective to this thread.
While I am not advocating competing with Ophthalmology, I am a strong believer in keeping and concentrating on "our" scope of practice. Our leaders may know more than we give them credit. Insurance companies are running the show. Our leaders could be trying to appease them and keep us in the game at the same time. Tough balance.
Many students do not understand the hoops that insurance companies make us jump through. Let me give you an example.
75 year old glaucoma patient on Xalatan. Med works well, controls IOP and central and peripheral vision is stable for a period of three years. Medicare D plan makes Xalatan a third tier med (which means the patient has to pay full price or a greater copay). Patient upset with extra cost, doctor upset because med works, insurance company clueless. The med must be changed, a new trial must be done with new med.....all this leads to increase in medical management. Bottom line - a waste of time and an increase in the strain on medical care.
This is what many private practice doctors deal with daily.
Now let me give you another thing to think about. If Optometrists were only on vision plans, the above example would not even need to be discussed on this board. 60 to 70 percent (rough figures) of practicing Optometrists don't deal with this, mainly because they only use vision plans. Sounds like less of a headache, doesn't it? My belief is that it leads to apathy.
I became an Optometrist to take care of patient's visual needs. That is the standard quote given by many Optometrists. Do we live it? I try. I have a busy private practice that is as medical as one can become. As KHE said in his post, most entering complaints are visual and refractive related. I appreciate this, but many of the underlying causes are medically related. If I was not trained in pathology and medical management, I would punt more than an 0 and 12 football team. I feel that I am resposible for the total care of my patient's eyes. Many conditions I can manage, some I can't. My training has given me the ability to make these decisions.
I am not a salesman. Optometry's roots come from spectacle peddlers. I respect that, but I did not go through Optometry school to peddle specs. I have Opticians who do that. I am probably missing the boat on this subject, but I feel that my practice is exactly the way I want it.
The vision plan problem will not go away. It is only going to get worse. This will ultimately lead to lower global reimbursement, poor patient care and Optometrists becoming welfare citizens. We must insulate ourselves from this evil.
Bottom line - get rid of vision plans, practice full scope Optometry, get paid what you are worth and live a happy life.
Give our leaders some credit. These are voluntary positions. They are fighting for us collectively, even though they are not fighting for you
individually.
Good luck,
Dr. Gump
PS No, I am not running for a position, and NEVER will. I just appreciate their voice. They allow me to practice the way I like.
