Will optometry ever disappear?

[FamilyMD]

---

Members do not see this ad.

So would you be more inclined to refer to an OD who you knew as part of your social circle?

If an OD wanted to garner referals for blurry vision, pink eyes, and screening for diabetic retinopathy, what would they need to do or what would you need to hear to make you consider the OD as a viable referal option?

For me personally, it's too late. I am close friends with several eyeMD's that we refer pts back and forth. They refer new pts to me and vice versa. I think if an OD established a referal pattern to a PCP, that PCP would be more inclined to do the same.
Another issue is more contentious, there is always liability issues, so if OD's somehow convince me they are just as competent as an eyeMD, it would be easier (and more comfortable) for a PCP to refer to him instead of an eyeMD where we know their extensive training track. Theoretically, if a pt has a bad outcome with an OD, the pt could try to sue the PCP for referring him to "a lesser" eye dr. Poor word choice, but you get my drift.

 

[cpw]

i met with the local MDs in the area to establish a relationship. family docs, in my opinion, seem to be the most caring provider ive ever been in contact with. in my experience, they simply wanted timely, efficient, and competent care for their referrals. if that meant an OD of MD for eye care, it didnt matter, but why would they pull my name out of thin air if i didnt make the effort to meet them?

I did this with a local urgent care clinic. One of their docs came in for an exam, told me he had no slit lamp, so I offered to see his "red eye" patients for him and told him he could call me for patients that called him on Saturdays since I was open and he was not. He's already sent me two people this week ! YAY!

 

[drgregory]

I did this with a local urgent care clinic. One of their docs came in for an exam, told me he had no slit lamp, so I offered to see his "red eye" patients for him and told him he could call me for patients that called him on Saturdays since I was open and he was not. He's already sent me two people this week ! YAY!

but imagine if you drove over to the local urgent care and said:

"hi! im the OD from the shopping mall."

MD: "great. which one - pearle, vision world, lenscrafters, sears, jcpenny, or macy's?"

you: "vision world. can you send me your medical eye cases? just have the patients report to the south entrance - the one by the 'payless shoes', and then three doors down, next to the 'pretzelmaker' is my office".

 

[rpie]

For me personally, it's too late. I am close friends with several eyeMD's that we refer pts back and forth. They refer new pts to me and vice versa. I think if an OD established a referal pattern to a PCP, that PCP would be more inclined to do the same.
Another issue is more contentious, there is always liability issues, so if OD's somehow convince me they are just as competent as an eyeMD, it would be easier (and more comfortable) for a PCP to refer to him instead of an eyeMD where we know their extensive training track. Theoretically, if a pt has a bad outcome with an OD, the pt could try to sue the PCP for referring him to "a lesser" eye dr. Poor word choice, but you get my drift.

Interesting point. However, wouldn’t you also be in a similar situation if you sent your diabetic patient that has a vitreous bleed to your general OMD and they did laser TX and zapped the macula?

Since you didn’t send them to a fellowship trained retinal specialist don’t you think you could be held liable?

When I was in OD education, I aware of a few cases where legal actions against the general OMD (for not having a the retinal sub-specialist do the surgery) and the PCP (for referring to, a “lesser doctor”) were initiated. One thing that was brought up was that if the PCP would have referred to an OD, the OD would have in most cases referred to a retinal specialist because he cannot do invasive surgery.

 

[drgregory]

One thing that was brought up was that if the PCP would have referred to an OD, the OD would have in most cases referred to a retinal specialist because he cannot do invasive surgery.

we have a retina guy on speed dial in our office. last month we had 27 SURGICAL retinal cases (many more 2nd opinions) that we sent to him. needless to say, our relationship with him is strong. he also proudly states that he doesnt remember how to use a phoropter, especially when prompted by me saying "i wouldnt want to touch grid or focal laser, even if i had the scope of practice ability, with a 10 foot pole - i dont have the balls. and everyone knows how big my ego is".
our cat/lasik surgeons, on the rare occasion they see patients for non-surgical consults, also send out anything "retino-questionable" to him for second opinion.

 

[FamilyMD]

Interesting point. However, wouldn’t you also be in a similar situation if you sent your diabetic patient that has a vitreous bleed to your general OMD and they did laser TX and zapped the macula?

Since you didn’t send them to a fellowship trained retinal specialist don’t you think you could be held liable?

When I was in OD education, I aware of a few cases where legal actions against the general OMD (for not having a the retinal sub-specialist do the surgery) and the PCP (for referring to, a “lesser doctor”) were initiated. One thing that was brought up was that if the PCP would have referred to an OD, the OD would have in most cases referred to a retinal specialist because he cannot do invasive surgery.

Anybody can sue anybody for anything. Common sense though would dictate I would be way for defensible by sending the pt to an eyeMD and then if HE drops the ball, it's much more difficult to hold me responsible because I did the STANDARD OF CARE. Maybe he didn't, but I DID. Whereas, it will be much easier for a hired gun to state the S.O.C. is not to refer (whatever the symptom is) to an OD, and it should have gone to an eyeMD. Again, I am not putting OD's down, but you know how lawyers are....

 

[drgregory]

Anybody can sue anybody for anything. Common sense though would dictate I would be way for defensible by sending the pt to an eyeMD and then if HE drops the ball, it's much more difficult to hold me responsible because I did the STANDARD OF CARE. Maybe he didn't, but I DID. Whereas, it will be much easier for a hired gun to state the S.O.C. is not to refer (whatever the symptom is) to an OD, and it should have gone to an eyeMD. Again, I am not putting OD's down, but you know how lawyers are....

great point -

think about it from our point of view - you get a 45 y/o patient coming in with a recent pupil involved CN3 palsy, you order imaging and send them ASAP to the neuroMD. sending them to a PCP could delay, and some frivilous lawyer could.......

but then how is it that NPs and PAs are providing general med care - isnt there more liability for the supervising MD in that than sending out the eye care and hoping the "doc on the other end" is competent? or does the PA/NP carry their own malpractice? i guess im speaking without a large knowledgebase on that.
i would assume any other independent provider of specialty, be it OD, MD, DPM, would be at fault if they dropped the ball on a consult/referral. but, like you said, you never know today...you might be best to send every secondary care level consult to a teaching institution/med school.

but, in our office, all consults go to the ODs, whether the referring PCPs or other providers know it or not (they eventually know it when they get the dictation letter back). the ODs wade through and pass on the surgical cases to the MDs.

 

[FamilyMD]

great point -

think about it from our point of view - you get a 45 y/o patient coming in with a recent pupil involved CN3 palsy, you order imaging and send them ASAP to the neuroMD. sending them to a PCP could delay, and some frivilous lawyer could.......

but then how is it that NPs and PAs are providing general med care - isnt there more liability for the supervising MD in that than sending out the eye care and hoping the "doc on the other end" is competent? or does the PA/NP carry their own malpractice? i guess im speaking without a large knowledgebase on that.
i would assume any other independent provider of specialty, be it OD, MD, DPM, would be at fault if they dropped the ball on a consult/referral. but, like you said, you never know today...you might be best to send every secondary care level consult to a teaching institution/med school.

but, in our office, all consults go to the ODs, whether the referring PCPs or other providers know it or not (they eventually know it when they get the dictation letter back). the ODs wade through and pass on the surgical cases to the MDs.

Well, we certainly won't solve anything here, but it is good to see how things are done elsewhere. I would certainly feel more comfortable in refering to a practice like yours where there is opthal back-up. It's refering to OD's in Walmart, Sears, etc. that makes me weary. I am happy to give insight as an earlier poster had requested.

 

[rpie]

Anybody can sue anybody for anything. Common sense though would dictate I would be way for defensible by sending the pt to an eyeMD and then if HE drops the ball, it's much more difficult to hold me responsible because I did the STANDARD OF CARE. Maybe he didn't, but I DID. Whereas, it will be much easier for a hired gun to state the S.O.C. is not to refer (whatever the symptom is) to an OD, and it should have gone to an eyeMD. Again, I am not putting OD's down, but you know how lawyers are....

I believe it depends upon what your state’s standard of care is. In many states you will find that the standard of care is to consider referring to either an MD or OD. Whether you feel it is common sense that you can defend your self better if you send to an OMD really depends on how much trust you have in what an OD can do.

When you refer to an OD or an OMD, both are considered “eye care specialists” in many states, so you have met the standard of care by referring to an appropriate specialist.

Unfortunately I can see that you cannot see your self working with an OD, which I can understand, and yes Attys. will try to sue everyone when a malpractice suit is filed. However, I have yet to see a successfully litigated case where a PCP got sued because they referred their patient to an OD for an ocular condition or consult. As a side note, I have reviewed a fair amount of cases where the OD got sued because they didn’t refer to the appropriate sub-specialists.

I think we all need to realize that a malpractice suit is usually filed when the patient feels that they were neglected and got substantiated care. These suits almost always results form a poor surgical outcome, this is why many general OMDs and ODs will refer to the subs. for retina, cornea, glaucoma blebs, etc.. Then in the event a lawsuit is initiated the subspecialties can show that the patient got the best possible treatment.

In all, my point is that since most ODs refer the same way that general OMDs and it is really up to the PCP as to whom they want to work with.

 

[drgregory]

It's refering to OD's in Walmart, Sears, etc. that makes me weary. I am happy to give insight as an earlier poster had requested.

you are using good judgment here. if i were you, i'd look to a younger, PRIVATE or HOSPITAL based OD practice - much of current OD training is admistered with med students in teh first year. and much of the clinical training includes instruction by staff ophthalmologists. but if the OD graduated in 1955, there is a majority chance that they were born before the invention of "the ophthalmic drop", and lack of active CE means they know little of it.
i think most OD groups, at least younger ones, are entering into marriage with eye-MD groups - so you are getting all-levels-in-one setups more and more. as soon as we get these dinosaur ODs and eye-MDs, who for some reason hate each other, out of the picture, the better it will be for eye care.

and did i mention that ODs working in environments like the shopping mall and walmart doesnt help anything?

 

[sethuel1]

and did i mention that ODs working in environments like the shopping mall and walmart doesnt help anything?

no, I don't think so.

 

[posner]

Well, we certainly won't solve anything here, but it is good to see how things are done elsewhere. I would certainly feel more comfortable in refering to a practice like yours where there is opthal back-up. It's refering to OD's in Walmart, Sears, etc. that makes me weary. I am happy to give insight as an earlier poster had requested.

Hey....what about the real professional doc-in-the-boxes where the OD's set their own fees(pimple-faced 22 year old district manager be damned) and have robust medical practices? Surely this wouldnt make you weary? Also I would like to know if strip mall location is at all important. Would one be more likely to refer to an OD adjacent to a Cutlery Barn or an Orange Julius?

I echo the sentiments of other posters in regards to the capabilities of newer ODs (and some older guys that have been progressive). Most of these guys are very capable of managing even semi complicated patients. Even though I do get referrals from several of the PCPs in my area, I have made an attempt to send all the PCPs and PAs in our area a letter explaining what I do. I am sure to let them know we are on call 24/7 for urgent care and that we have Ophthalmology in the office should the need arise. Whether it makes a difference or not I dont know. I feel strongly that you should never miss an opportunity to educate the healthcare community on what we do. Some of these guys/gals have no idea.

Posner

 

[rpie]

Hey....what about the real professional doc-in-the-boxes where the OD's set their own fees(pimple-faced 22 year old district manager be damned) and have robust medical practices? Surely this wouldnt make you weary? Also I would like to know if strip mall location is at all important. Would one be more likely to refer to an OD adjacent to a Cutlery Barn or an Orange Julius?

I echo the sentiments of other posters in regards to the capabilities of newer ODs (and some older guys that have been progressive). Most of these guys are very capable of managing even semi complicated patients. Even though I do get referrals from several of the PCPs in my area, I have made an attempt to send all the PCPs and PAs in our area a letter explaining what I do. I am sure to let them know we are on call 24/7 for urgent care and that we have Ophthalmology in the office should the need arise. Whether it makes a difference or not I dont know. I feel strongly that you should never miss an opportunity to educate the healthcare community on what we do. Some of these guys/gals have no idea.

Posner

LOL …… Posner I though that by the age of 22 most of the Zits were gone. hummm, maybe not, but what do I know. The picture that comes to my mind is 18-20 Y.O.s, who are the “Optical store managers” 😛

Now that’s what I call impressive. A pizza face kid that recently finished high school, working their way though college and trying to study for the ABO certification test so they can be a regional manager. 😀

In all fairness, you have to give these kids credit because they are trying hard to make something of them self.🙂

 

[plum]

hi everyone

i'm an australian optometrist. so we do not get given doctor titles and it's a 5 yr undergrad course. the therapeutic prescribing has just come into effect in some states, but is not in the majority and we do WAY LESS medical stuff cf to O.D. so far we can only prescribe easy drugs like chloramphenicol (please forgive my spelling, in my state NSW, we can't prescribe yet) no antiviral, can only write a repeat of a glaucoma drug and some patanol and anti histamine stuff.

It's interesting reading this post, because i actually assumed that over in the states, Ophthals would be put out of business as it seems like ODs get to do pretty much everything. however it seems that the public perception of optoms just being glasses person hasn't seem to changed much althou u have had Prescription rites for over like 30 years i think? think i read somewhere that it came into effect in 1970s?
Currently i'm considering leaving optom and doing med. the public perception over here is optom being glasses person and is viewed more like a business person rather than a health professional. althou this is slowly changing esp wit younger ones who realise how hard it is to get into optometry and see that we actually DO know stuff about eyes, not just glasses, i feel that for me i won't be happy just being stuck in a very business orientated profession. yes, there are few optoms here that are very good in the medical side of things however they all always be seen as 'just an optom'.

Australia seems to follow America's health trends. so i was interested to find out how optometry worked over there and seeing what optom future here would be like in 20 yrs. it is discouraging to see that public perception still hasn't seem to changed very much regarding OD. althou u guys get the dr title!! A lot of things have already happened over here similar to US. Big monster optical franchises trying to kill off independent optometrist practices, supermarkets wanting to have their little corner optical store (hasn't been all that sucessful thank god!) and obtaining therapeutic prescription rights. and there is a floating rumour that optom is to become a post grad course and get called OD!

I thought that ODs would be doing FB removal, glaucoma work up, treating uveitis etc WAY MORE than just selling glasses and CLs. am I wrong in my preassumpitoN?

 

[Eyegirl2k7]

I'm a 4th year OD student. As far as foreign body removal goes, I removed a corneal foreign body with a golf club spud two weeks ago. It was a small piece of rock from yard work. Prescribed Tobradex and sent him on his way. The patient came back a few days later and his cornea was completely clear--no scarring, no edema, no issues. Vision back to normal. Didn't need an MD behind my name for that.

 

[PBEA]

I thought that ODs would be doing FB removal, glaucoma work up, treating uveitis etc WAY MORE than just selling glasses and CLs. am I wrong in my preassumpitoN?

Welcome to the forum, its interesting to hear some first hand australian OD insight. You are correct, ODs in the US treat way more then they used to, but glasses and CLs is always going to be the number one reason most people seek an eye exam. In fact, as you know, many people obtain examination for "glasses" when they are really having other issues. That is the unique position that ODs (and OMDs) have with regard to screening for and in most cases treating these conditions as they present. That is why an "eye examination" has evolved to require assessment beyond refraction/vision, because a "vision" exam is basically a false sense of security for the patient and the doctor. 20/20 vision does not always mean you have "healthy" eyes or that you are a "healthy" person.

 

[PBEA]

I'm a 4th year OD student. As far as foreign body removal goes, I removed a corneal foreign body with a golf club spud two weeks ago. It was a small piece of rock from yard work. Prescribed Tobradex and sent him on his way. The patient came back a few days later and his cornea was completely clear--no scarring, no edema, no issues. Vision back to normal. Didn't need an MD behind my name for that.

I think using tobradex in the setting of an acute, dirty FB, which no doubt left an ulcer, is a poor choice. IMHO

 

[POJO]

I'm a 4th year OD student. As far as foreign body removal goes, I removed a corneal foreign body with a golf club spud two weeks ago. It was a small piece of rock from yard work. Prescribed Tobradex and sent him on his way. The patient came back a few days later and his cornea was completely clear--no scarring, no edema, no issues. Vision back to normal. Didn't need an MD behind my name for that.

Dear Eyegirl2k7,

I think such a comment should deserve a bit more thought before posting it. Such a characterization of a potentially sight threatening condition as a "dirty" foreign body" is not something that should be left to some kind of formula.

Therefore saying that a corneal foreign body can easily be treated with a combination antibiotic / steroid topical medication is simply a reflection of a lack of experience on your part. These things can turn on a dime.

 

[POJO]

For me personally, it's too late. I am close friends with several eyeMD's that we refer pts back and forth. They refer new pts to me and vice versa. I think if an OD established a referal pattern to a PCP, that PCP would be more inclined to do the same.
Another issue is more contentious, there is always liability issues, so if OD's somehow convince me they are just as competent as an eyeMD, it would be easier (and more comfortable) for a PCP to refer to him instead of an eyeMD where we know their extensive training track. Theoretically, if a pt has a bad outcome with an OD, the pt could try to sue the PCP for referring him to "a lesser" eye dr. Poor word choice, but you get my drift.

Dear FamilyMD,

I agree that just because you have an OD degree doesn't means that you're smart enough or good enough to see your patients. You have to work for it.

I receive referrals from over 30 primary care physicians on a weekly basis and have worked to fulfill their expectation and confidence. This has been a long 4 yr personal journey filled with diligence and good professional networking. I don't for a second think that I'm not under some kind of microscope by any or all. Fortunately, I have endured the most stringent credentialling process that I can imagine any OD can endure and have succeeded in.

 

[exmike]

I'm a 4th year OD student. As far as foreign body removal goes, I removed a corneal foreign body with a golf club spud two weeks ago. It was a small piece of rock from yard work. Prescribed Tobradex and sent him on his way. The patient came back a few days later and his cornea was completely clear--no scarring, no edema, no issues. Vision back to normal. Didn't need an MD behind my name for that.

wow, such hubris! i'm sure any OMD would applaud your great work. I'm not sure what your point is other than to beat your chest and say "i'm just as good".

 

[hye345]

bookmarking

 

[drbizzaro]

Dear FamilyMD,

I agree that just because you have an OD degree doesn't means that you're smart enough or good enough to see your patients. You have to work for it.

I receive referrals from over 30 primary care physicians on a weekly basis and have worked to fulfill their expectation and confidence. This has been a long 4 yr personal journey filled with diligence and good professional networking. I don't for a second think that I'm not under some kind of microscope by any or all. Fortunately, I have endured the most stringent credentialling process that I can imagine any OD can endure and have succeeded in.

as long as we take each instance with care and caution... and not act all cocky about doing stuff, we're just as good

 

[Spearmint1]

stop being ******ed - quit bringing up old postings

 

[hfpepperbean47]

As long as there are 600 million eyes in this country (rough estimate) and new pairs coming every day, then optometry will never go away

 

[drbizzaro]

stop being ******ed - quit bringing up old postings

i personally think the older postings are way more interesting than the new things being brought up...

if it bothers you so much, just dont read the posts that i make.... it's as simple as that...

 

[eyelectric]

i personally think the older postings are way more interesting than the new things being brought up...

if it bothers you so much, just dont read the posts that i make.... it's as simple as that...

You know at first I thought it was annoying that you were bringing back old posts, but you have actually found some good ones which have piqued my interest. These are posts which I never would have found otherwise. I guess its all part of being Dr. Bizzaro, huh?

 

[EastCoaster78]

what's up with medical insurance not covering OD appt's? I needed new glasses and since I didnt have vision coverage it would've costed me $120 to see on OD.So since I have $30 copays for med specialists I called the closest ophthalmologist, bam. new glasses next day. So I kinda wonder what's the point of a separate profession.

Especially when oplohomolgists have more training and its less of a hassle to see one.

 

[UABopt]

what's up with medical insurance not covering OD appt's? I needed new glasses and since I didnt have vision coverage it would've costed me $120 to see on OD.So since I have $30 copays for med specialists I called the closest ophthalmologist, bam. new glasses next day. So I kinda wonder what's the point of a separate profession.

Especially when oplohomolgists have more training and its less of a hassle to see one.

This has nothing to do with ophthalmology vs. optometry. You could have just as well used your insurance at an optometrist. As long as the OD is on the panel. The problem is most major medical ins. do not cover a general eye exam. That is to say they will not cover an eye exam unless you have a medical problem and a medical diagnosis. This is true with an OD or an OMD! Refractive error does not count as a medical diagnosis. If you have no vision insurance and your OMD accepted your major medical he made a "medical finding." so if you look at the ICD-9 code on your chart it will be something medical if you are younger likely something like bleph, or DES etc..etc.. You have to understand though, that if you go to your eye doctor and you dont have a medical complaint ie "my eyes are dry/itchy/burn/red...etc" or "I have been diagnosed with Cataracts/Glaucoma and need a check up...etc" we cannot successfully bill your insurance. Additionally pulling a diagnosis out of somebody who does not have a medical complaint is often seen as insurance fraud. Furthermore major medical hardly ever covers refraction so you have to pay that on top of your copay unless the doctor decides to eat it.

The whole system is entirely screwed up if you ask me, or for that mater, most other people. It is a huge problem because people come in with blurry vision. That complaint could have either a refractive or a medical source. The patient does not know if it is cataracts and glaucoma that is causing their vision to be blurry or if it is just the fact that they need a little extra minus in their prescription. You can see where that creates a dilemma, the patient does not know upfront if the office visit will be paid for by insurance or not. It's all about playing the game.

 

[eyelectric]

what's up with medical insurance not covering OD appt's? I needed new glasses and since I didnt have vision coverage it would've costed me $120 to see on OD.So since I have $30 copays for med specialists I called the closest ophthalmologist, bam. new glasses next day. So I kinda wonder what's the point of a separate profession.

Especially when oplohomolgists have more training and its less of a hassle to see one.

I find it ironic that ophthalmologists have no problem encroaching on optometric territory, however when optometrists attempt the opposite, ophthalmology doesn't like it so much.

 

[deleted6669]

most people with something stuck in their eye care not whether you're on their insurance or not.. they just want the thing OUT OF THEIR EYE!

honestly most of these folks show up at the emergency dept when they get an fb in their eye. I see numerous cases/week. usually related to use of a grinder or welding at work although we also see a lot of more benign cases and fingernail in the eye kind of stuff.
I have lots of respect for the local o.d. group and send them frequent referals for f/u. they also are really good about sending pts into the e.r. when they have eye related sx due to extra-occular dz like the 30 yr old female with a new onset cva they picked up and sent in for further eval.

 

[IndianaOD]

what's up with medical insurance not covering OD appt's? I needed new glasses and since I didnt have vision coverage it would've costed me $120 to see on OD.So since I have $30 copays for med specialists I called the closest ophthalmologist, bam. new glasses next day. So I kinda wonder what's the point of a separate profession.

Especially when oplohomolgists have more training and its less of a hassle to see one.

Yup, this has fraud written all over it. If it is true MEDICAL insurance that does not have a VISION plan incorporated with it then it will never cover a basic eye exam. You would probably get a much more thorough exam with an OD. (As long as its not a commercial/retail doc). Also, ODs actually know how to refract! 🙂

 

[IndianaOD]

I find it ironic that ophthalmologists have no problem encroaching on optometric territory, however when optometrists attempt the opposite, ophthalmology doesn't like it so much.

Either that or they just call it quackery. Most of them think vision therapy is hocus-pocus. Now that quality double-blind randomized clinical studies are showing how good it really is, I wonder what the next line will be.

Imagine, in a lot of cases I can improve binocular vision and/or eliminate causes of headaches without a scalpel.

 

[eyelectric]

Either that or they just call it quackery. Most of them think vision therapy is hocus-pocus. Now that quality double-blind randomized clinical studies are showing how good it really is, I wonder what the next line will be.

Imagine, in a lot of cases I can improve binocular vision and/or eliminate causes of headaches without a scalpel.

Ah, yes, the age-old argument: "This is the way it has always been done and therefore this is the way it should continue to be done". I'll let the little guy drive my point home for me (he's cuter than I am, although not he's as cool as the violin guy):