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Message
re: Optometry: LA HB 1065/SB 568: What if your Louisiana Eye Surgeon is NOT an MD?
Posted on 5/17/14 at 1:27 pm to Bmath
Posted on 5/17/14 at 1:27 pm to Bmath
quote:
Give them the opportunity to get the resident training. They don't need to do major surgery, but there are some procedures that they can and have very safely perform.
I'm all for post-optometry fellowships, particularly under Ophthalmologists and even Ophth-trained Optometrists (because Optom schools do not train for the things being taught, whereas Ophth residencies do). But they need to be governed under the LSBME so that they're held to the same standards for the same procedures.
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Posted on 5/17/14 at 1:32 pm to LATigerdoc
Explain the non-invasive part. Is it non-invasive to shoot a laser past the corneal epithelium, bruchs membrane, stroma, descemets membrane, endothelium, anterior chamber, iris, intraocular lens implant, and then into the membrane behind where the lens was? That sounds kind of surgical
This post was edited on 5/17/14 at 1:32 pm
Posted on 5/17/14 at 1:35 pm to Bmath
quote:
Then allow them to have this opportunity.
To compete for MD residencies? That's not what they chose to go to school for! If someone went to OD school to compete for an MD residency spot, I'd question their idea of what they got themselves into. I would be all for a dual OD/MD degree with an early match into an Ophth program kind of like the DDS/MD-->OMFS programs that exist. I also wouldn't do this, because it just tacks an extra 2 years on for very little-to-no benefit for the applicant.
On the other hand, I would be willing to bet that just about any OD could apply to Medical School, probably have 90-100% of his first 2 years waived, go through 3rd and 4th year and then be a wildly compelling applicant to the Ophth program of their choice because they'll have unmatched experience. To have them have that leg-up straight out of Optometry school just isn't the same, though. The "survey experience" you get in 3rd and 4th years of medical school is paramount to becoming an ophthalmologist. The specialization that Optometrists get during these same two years is equally as important for them not needing a residency program to treat basic eye pathology and perform basic eye health examinations.
Posted on 5/17/14 at 1:37 pm to Bmath
quote:
My opinion is that there should be an expanded residency opportunity for them. That is all. They could still have the oversight of an ophthalmologist, but it would be a great way to expand their role properly.
There are Optometry fellowships in cornea, glaucoma, and retinal pathologies if I'm not mistaken. They don't extend to the level of surgical expertise, though. They extend to the co-management level. The Optometrist I used to go to had done a glaucoma fellowship and did great things for his patients. When they needed procedures performed, he referred them to an ophthalmologist who was always happy to take his patients. They each had their role in management, and it worked very great. These things exist.
Posted on 5/17/14 at 1:38 pm to Hopeful Doc
I'm not sure where you're coming from saying there's no significant difference in the first two years of medical school vs pt, etc. Go ask some first years in biochem or some second years in step 1
Posted on 5/17/14 at 1:42 pm to LATigerdoc
How can you take a better look at the focused area in your first 2 years and still learn very similarly/ cover all the same stuff? If people studied any longer or harder than the people in first and second years of med school, they would have to either 1) not sleep 2) be on some artificial pharmacological enhancement or 3) be from an alien species
This post was edited on 5/17/14 at 1:43 pm
Posted on 5/17/14 at 1:46 pm to Bmath
quote:
Right, but they can still fill a role of someone that went to medical school. I'm not talking about full board certification in a certain discipline, but why not allow optometrists to fill a certain role?
In LA, an NP can only practice in collaboration with an MD. They do not take their place.
quote:
They are trained to do more than prescribe glasses, and most have the ability to do far beyond this. Why force them to go to more school? Why not allow them to at least receive residency training? If they are poorly trained, would they not simply wash out?
Many do much more than prescribe glasses, though it is the majority of most of their practices. Plenty of them work in conjunction with an Ophth and see things that don't need MD level clearance (much like NPs in conjunction with MDs in Primary Care). Further, you act as if NPs don't undergo further schooling than just Nurses. It's not a matter of more school, it's a matter of more training, regardless of the form it comes in (school vs internship experience). If they want to expand their scope to the point that they perform procedures traditionally performed by the MDs without MD oversight, I'm all for it. But it needs to be governed by the same board so that there is one, single level of care throughout the state. And then numbers and complication rates will be given to the same entity. They'll see that the OD group has the same level of complications and be more open to allowing them to do more procedures. Or they'll find the things where the complication rate is lower in the MDs and realize that that's where the role-expansion of OD's needs to stop without further training. When you allow a separate board to perform this kind of oversight, there is no guarantee for equal outcome measures. That's something I am wildly opposed to. Not only, then, is there the potential for poor outcomes for patients, but it then has potential to create a larger practice for management of complications for the ophthalmologists. Not necessarily under this set of procedures (though totally within the realm of possibility) but among the next that they will undoubtedly push for. Or the ones after that.
With the same oversight, I don't care if it's a monkey and an ophthalmologist performing the same procedure, so long as their outcomes are the same. If it's determined that one group has inferior outcomes, the one governing body will impose restrictions or additional requirements on the other group. I fail to see how that is not win/win.
Posted on 5/17/14 at 1:48 pm to LATigerdoc
quote:
I'm not sure where you're coming from saying there's no significant difference in the first two years of medical school vs pt, etc. Go ask some first years in biochem or some second years in step 1
I guess my argument is that they are "similar enough for all practical purposes," thus the ability of those with a DDS can enter into the 2nd year of MD programs and take only 1-2 classes before passing Step 1 and going onto the third year.
Posted on 5/17/14 at 1:52 pm to Bmath
quote:
You said it yourself that optometrists can't perform eye surgeries because they didn't receive a holistic training like MD's. Why is this not the same for a DDS?
Because DDS programs train their students to perform these surgeries. OD programs do not, particularly because there are very few ODs certified to perform these procedures themselves.
Posted on 5/17/14 at 1:53 pm to Hopeful Doc
You will never see ODs fall under the medical board. ODs scope would never expand. Look to Oklahoma, a state where ODs have been doing these procedures for over a decade if you'd like to see how an OD comapres to an MD as far as success, complication rates.
Posted on 5/17/14 at 1:58 pm to guttata
Cool. So I can be an Eye Surgeon now, if I just go to Optometry School.
Wow! I'm checking out what Mercedes I'm going to get, and what color script I want on my white coat right now!
And my Mom never thought I'd amount to anything!
Wow! I'm checking out what Mercedes I'm going to get, and what color script I want on my white coat right now!
And my Mom never thought I'd amount to anything!
Posted on 5/17/14 at 2:04 pm to LATigerdoc
Well if people didn't know the difference between an optom and an ophthalmologist before, they will now! I think ultimately the optoms are going to do themselves more harm than good with generating public mistrust and souring good working relationships with the medical community- while the real competition will be the autorefractor gadgets that make glasses for you at Wal-Mart
This post was edited on 5/17/14 at 2:06 pm
Posted on 5/17/14 at 2:06 pm to SmackoverHawg
quote:
Yep. I tried getting pissed and fighting it, but it only made me angry, bitter, and miserable. Then I see other physicians, albeit a minority, doing unethical shite and practicing well below normal standards of care. In those cases, a decent, ethical midlevel would be better. Our on colleagues are our worst enemies. The shitheaded outliers ruin our reputations and set the bar low for quality issues. We all get lumped in together. It got quite frustrating. I know in primary care, I get pissed to see other FP's just acting as glorified NP's and not doing the jobs they were trained to do. It's hard to fight the NP's and PA's when in fact some are better than these guys/gals. Of course the vast majority of these inadequately trained unethical physicians are foreign trained. There is a reason and purpose behind med school selection and matriculation. Even in our schools, I've seen them accept way too many unqualified students in a push to graduate more doctors. It dilutes the field and makes us all look bad. If they'd make medicine a more attractive field to pursue, and more lucrative for primary care, the quality students would easily fill those spots. As is fewer and fewer are drawn into medicine and the standards have been lowered intentionally or not. I for one do not think the overall quality of our physicians is nearly as good as it was 30 years ago. I attribute much to the watering down of primary care training. Even when I was a resident, they were moving the focus away from real medicine and toward more of a NP, social worker type role for FP's. I took the initiative to get additional training in internal med, peds, surgery, and derm to expand my skill set and knowledge base. Most do not and have allowed themselves to be replaced by midlevels. I'm not worried personally, but I am worried for the entire future of primary care.
FP's (and all PCPs, for that matter) that play "referral gate or go home" for their patients are a major problem in the medical community. There's not an FP residency that limits you to such things. There's very few doctors as badass as a real good FP in an area without direct access to specialists. If I wasn't halfway committed to not living in a rural area, I'd almost unquestionably go into Family. And once I was set up to do so, I'd probably have a PA/NP in the office as well.
Posted on 5/17/14 at 2:08 pm to guttata
quote:
NPs and CRNAs are a whole different ballgame since they fall under their own boards.
On a similar note, I have no problem with freestanding NP clinics, so long as they're governed by the LSBME and not whatever the proper name for the LA State Nursing Board is.
CRNAs, I honestly don't quite have the experience to know where I draw the line on wanting them vs an MD Anesthes in the room. For conscious sedation and the like, CRNAs are great. If I were doing a CABG or a liver transplant, I'd probably want the MD just to have a little less to worry about when the shiteth undoubtedly hitteth the fanneth.
Posted on 5/17/14 at 2:10 pm to guttata
quote:
Look to Oklahoma, a state where ODs have been doing these procedures for over a decade if you'd like to see how an OD comapres to an MD as far as success, complication rates.
I've had trouble finding these numbers. I stated that earlier in the thread, if I am not mistaken. Do you happen to have a link to their published operation vs complication rates as well as what they call a complication?
Posted on 5/17/14 at 2:16 pm to Hopeful Doc
quote:
There's not an FP residency that limits you to such things
I disagree to a point. And I am only speaking of the residencies here in Arkansas because that's all I have knowledge of. When I was a resident the head of the entire AHEC program was a dentist. The head of our program when I finished was a phD in f$%king physical education. That's right...an old coach. Neither of which knew jack shite about medicine. Their educational priorities were completely f$%ked and "real medicine" was not stressed. I went out and got additional training on my own, but it was not readily available. In Arkansas, the FP's coming out now are nothing more than glorified FP's unless they go above and beyond to gain additional skills and knowledge. It's so watered down compared to what is was 30-40 years ago it's ridiculous. They are in no way ready to provide care in rural areas where an abundant specialists referral pool is non existent. I think the whole thing should be overhauled and focused changed to be more like the old do everything small town docs. The residency would have to be 5-6 years, but if they will reimburse primary care adequately, it would lower cost and improve access to care far more than anything they are doing now.
Posted on 5/17/14 at 2:23 pm to Hopeful Doc
quote:
CRNAs, I honestly don't quite have the experience to know where I draw the line on wanting them vs an MD Anesthes in the room. For conscious sedation and the like, CRNAs are great. If I were doing a CABG or a liver transplant, I'd probably want the MD just to have a little less to worry about when the shiteth undoubtedly hitteth the fanneth.
cRNA's are good at what they do, but their medical knowledge is greatly lacking. My brother is one and could not get into med school. He graduated KU meds cRNA program with a 4.0 and has to ask me some of the most basic questions not related directly to anesthesia. I also find it absurd that he practices independently at a outpt surgery center (for an ophthalmologist) and gets the SAME reimbursement as an MD would. So basically he just bypassed the whole system to be paid as an MD with much less training, debt, and knowledge.
Posted on 5/17/14 at 2:24 pm to SmackoverHawg
quote:
When I was a resident the head of the entire AHEC program was a dentist. The head of our program when I finished was a phD in f$%king physical education. That's right...an old coach. Neither of which knew jack shite about medicine. Their educational priorities were completely f$%ked and "real medicine" was not stressed.
I'll go ahead and retract my statement, then. That does sound like a pretty poor system.
quote:
I think the whole thing should be overhauled and focused changed to be more like the old do everything small town docs. The residency would have to be 5-6 years, but if they will reimburse primary care adequately, it would lower cost and improve access to care far more than anything they are doing now.
5-6 years might be a little much unless you're in a community without so much as a general surgeon and want to perform some amount of your common traumas (appendectomies, cholecystectomies, etc) and primary C-sections as well. I would imagine that without a state- or local-sponsored malpractice coverage, that would be a farce to practice, though.
Posted on 5/17/14 at 2:29 pm to SmackoverHawg
quote:
I also find it absurd that he practices independently at a outpt surgery center (for an ophthalmologist) and gets the SAME reimbursement as an MD would. So basically he just bypassed the whole system to be paid as an MD with much less training, debt, and knowledge.
I suppose the argument can be made that he won't be practicing without an MD in the room, but even still; I don't want a complex surgery without two physicians in the room. One worried about surgery, and the other who has an eye on my vitals at all times. In an outpatient setting for something like a colonoscopy center, it's not such a bad thing. As someone nearing the end of med school and racking up enormous amounts of debt while deciding where to spend extra money on aways and interviews, I almost half wish I went to CRNA school and got hired by a fancy "30 minute surgery" center. Unfortunately, I wouldn't be happy doing it, and a little bit more than just money went into my decision.
Do you do scopes as an FP?
Posted on 5/17/14 at 2:34 pm to Hopeful Doc
Sounds like Smack is surrounded by a bunch of book smart people who don't know how to take their knowledge to real life situations.
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