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Started By
Message
re: Optometry: LA HB 1065/SB 568: What if your Louisiana Eye Surgeon is NOT an MD?
Posted on 5/17/14 at 2:35 pm to Hopeful Doc
Posted on 5/17/14 at 2:35 pm to Hopeful Doc
quote:No one has been able to find them. Onmymedicalgrind searched Pubmed and some other sources with no luck.
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?
Unknownknight did find a study pertaining optometrists use of ophthalmic exams in pts being evaluated for cataract surgery.
quote:
Variation in Ophthalmic Testing Prior to Cataract Surgery: Results of a National Survey of Optometrists
quote:
Ninety-two of 130 eligible responding optometrists reported that they routinely performed preoperative testing on patients being considered for cataract surgery. Of these 92 optometrists, 91 (99%) frequently or always performed refraction, and 82 (89%) frequently or always performed a dilated fundus examination in their evaluation of patients being considered for cataract surgery who had no history of other eye disease. None of these 92 optometrists reported using B-scan ultrasonography or electroretinograms frequently or always, and few used A-scan ultrasonography or visual evoked responses frequently or always. A substantial percentage frequently or always used formal visual field testing (47%), formal color vision testing (40%), fundus photography (24%), potential acuity measurement (25%), glare testing (23%), contrast sensitivity testing (19%), and specular microscopy (14%), while 11% to 81% of optometrists never performed these tests on such patients. More recent graduation from optometry school was associated with a decreased frequency of use of potential acuity measurement and contrast sensitivity testing and with an increased use of dilated fundus examinations.
quote:
Conclusion: There is a substantial variation in optometrists' self-reported use of a number of ophthalmic tests in the preoperative evaluation of patients being considered for cataract surgery who have no history of other eye disease.
LINK
An ophthalmologist would probably be able to make more sense of that.
This post was edited on 5/17/14 at 2:36 pm
2
Posted on 5/17/14 at 2:35 pm to Hopeful Doc
quote:
you do scopes as an FP?
I used to, but the reimbursement isn't worth missing clinic time unless I was in an outpt surgery center. Some ortho's built one and brought in the local GI, but wouldn't give me a slot. So I quit. Now the GI has to do all the emergent scopes at the hospital himself. Me and my partner are by far the two biggest referral sources in our area and have since found others to refer our business too. The recently offered us a stake, but we turned them down. They are now being bought out by an outside group. So future specialist beware, don't piss off your referral sources. Pt's go where we tell them to.
I kinda miss being able to get a scope done when I need it and being able to do them on pt's in need but can't afford it. The GI's do zero pro bono work despite being raging liberals.
Posted on 5/17/14 at 2:37 pm to SmackoverHawg
Posted on 5/17/14 at 2:38 pm to guttata
Quote:
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.
__________________________________________________
Smack speaks the truth. And books aren't such a bad thing.
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.
__________________________________________________
Smack speaks the truth. And books aren't such a bad thing.
This post was edited on 5/17/14 at 2:40 pm
Posted on 5/17/14 at 2:42 pm to Hopeful Doc
quote:Been trying to save up my loan money for that next year. Damn heat down hear causes bills to skyrocket and keeps chipping away. The 2nd half of 4th year should be a cakewalk though once I get through the hell that is the first 6 months.
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
Step 2
Month of peds nephrology
Month of peds AI
Month of away
Month of interviews and travel
Month of peds infectious disease away/interviews
Plan on scheduling a whole month of vacation for my last month of school though.
This post was edited on 5/17/14 at 2:43 pm
Posted on 5/17/14 at 2:46 pm to LATigerdoc
LATigerDoc has to preserve his demesne.
Louisiana on the forefront
Louisiana on the forefront
Posted on 5/17/14 at 2:51 pm to Scruffy
quote:
An ophthalmologist would probably be able to make more sense of that.
Based on that, it's not a terribly strong/impressive "they're doing it right/wrong" kind of thing. If they've been following these patients for a long time and know they don't have concomitant eye disease + the cataract isn't dense enough to prevent normal fundoscopy, the lack of ultrasonography used isn't necessarily alarming. If these are new patients and they're referring for cataract surgery, it's still not terribly alarming, because the ophth is going to want his own imaging anyway, I'm sure.
Absence of fundus photography in a cataract patient, depending on the severity of the cataract (not mentioned) maybe even a plus. You're going to get a blurry picture at best (if it's bad enough to be getting referred to surgery).
In short, with the knowledge a particularly ophth-interested 3rd year medical student, these numbers are really just numbers that don't say anything. The study would be heavily strengthened by comparing these numbers to 130 (or more) cataract-centric ophthalmologists. I don't see anything here that jumps out. I also am not necessarily positively sure of preop indications of each of these tests. I do believe that some pretty firm/solid retinal imagine (including dilated exam) is pretty necessary preoperatively, I'm not sure how it's indicated in the patient you've seen for 30 years with no other problems vs the guy who came in today who reports no other problem, which is also not specified in what I'm reading.
This post was edited on 5/17/14 at 3:09 pm
Posted on 5/17/14 at 2:53 pm to Hopeful Doc
What you stated is about what I got out of it. There really aren't any studies pertaining to optometrists as far as I can find.
Posted on 5/17/14 at 2:54 pm to SmackoverHawg
quote:
I used to, but the reimbursement isn't worth missing clinic time unless I was in an outpt surgery center
Even if the reimbursement isn't quite right, I think I need that half-day scheduled where I'm doing a procedure I do frequently where I can kind of "zone in and put the rest of the world out of my mind," if that makes sense. I'm thinking of going a few different routes still, but it would easily be taken up by cataracts, scopes, cath lab, or bronchs (which should pretty well tell you that I've got 4 fields in mind and really haven't made my mind up yet).
ETA: As to the rest of your post
at them. This post was edited on 5/17/14 at 2:55 pm
Posted on 5/17/14 at 2:57 pm to Hopeful Doc
I do plenty of in office procedures. Mostly derm stuff. Of those options, I would pick ophth or GI for overall lifestyle/pay etc. But good pulmonologist are hard to find, and you can make a ton on sleep studies and allergy testing/treatment.
Posted on 5/17/14 at 3:00 pm to Scruffy
quote:
Been trying to save up my loan money for that next year. Damn heat down hear causes bills to skyrocket and keeps chipping away. The 2nd half of 4th year should be a cakewalk though once I get through the hell that is the first 6 months.
Step 2
Month of peds nephrology
Month of peds AI
Month of away
Month of interviews and travel
Month of peds infectious disease away/interviews
I'm front-loading through Christmas as well.
Month of required stuff that the school assigns randomly (and CK during that block)
CS to start a month of FM AI
Away month in Ophth
Home month in Ophth
Off month for vacation/interviews
Medicine month, likely Cards or Pulm.
Month of outpatient
haven't really decided on what I'm doing once January hits yet.
Posted on 5/17/14 at 3:04 pm to Hopeful Doc
My whole goal for the 2nd half is to do as little as possible. I'm gonna try to get a bunch of crap, do nothing courses so I can enjoy the end before residency. Throw CS in there somewhere. Ending on a 1 month vacation though. That is the one element of my schedule that isn't going to change.
Posted on 5/17/14 at 3:04 pm to SmackoverHawg
quote:
ophth or GI for overall lifestyle/pay etc. But good pulmonologist are hard to find, and you can make a ton on sleep studies and allergy testing/treatment.
I'd actually be doing FM rather than GI if I could find the right place to practice. I like the derm procedures that FM does a lot, I like continuity of care; it would have to be in a traditional setting, though. I don't want to admit my patients to a hospitalist. I'm pretty worried about how competitive I am in ophth. I've got a lot of experience that most applicants don't have, but board scores and research (which are absurdly high in that field) are both knocks on me. As far as Pulm vs Cardio goes, I really like both. It's really a coin flip, other than I think the cath lab is cooler than sleep studies and bronchoscopy (and I'm not minimizing all the other clinic vs inpatient aspects).
I guess when it comes down to it, I'll be happy with wherever I wind up.
Posted on 5/17/14 at 3:07 pm to Scruffy
quote:
My whole goal for the 2nd half is to do as little as possible. I'm gonna try to get a bunch of crap, do nothing courses so I can enjoy the end before residency. Throw CS in there somewhere. Ending on a 1 month vacation though. That is the one element of my schedule that isn't going to change.
Yeah. I would still have 2 vacation blocks to burn in 3 available time periods in that 2nd semester. We end with some required lectures in our last block, unfortunately. But it's kind of a joke, from what I understand.
Posted on 5/17/14 at 3:46 pm to SmackoverHawg
Smackover, how's the outlook on sleep studies? I hear they are trending to be done in the patient's home, thereby knocking out your facility fee.......
Posted on 5/17/14 at 3:55 pm to G Vice
Louisiana on the forefront... of implementing DC style left wing utopian healthcare makeovers
This post was edited on 5/17/14 at 3:56 pm
Posted on 5/17/14 at 3:59 pm to LATigerdoc
Oh my. That Oregon link is fascinating. What exactly is the scope of practice of a chiropractic proctologist?
Posted on 5/17/14 at 5:40 pm to LATigerdoc
quote:
Oh my. That Oregon link is fascinating. What exactly is the scope of practice of a chiropractic proctologist?
Haven't you heard of an 'arse Crack?'
LOL. I think a real-life 'Chiropractic Proctologist' is about the funniest damn thing I have heard about in a while.
Chiropractic Proctologist Surgery Allowed
This post was edited on 5/17/14 at 5:52 pm
Posted on 5/17/14 at 7:33 pm to G Vice
quote:
Smackover, how's the outlook on sleep studies? I hear they are trending to be done in the patient's home, thereby knocking out your facility fee.......
This is true. But it can still be lucrative. I don't do them in home because then the respiratory supply company wants me to do all the management and f/u for free. frick them. They make the money, they can do the damn work. I'm fine with a specialist doing it in home. Otherwise, I'll do the things my damn self.
ETA-it's ridiculous how much these companies make off of our work. We cannot own them however due to Stark laws. I don't give them shite. I love when they call and demand for me to do shite that makes them money or to go back and add to a note. That's fraud btw. Like I'm gonna commit fraud to make them some cash on some shite they should've never given the patient. I then inform the patient that they are not liable for a single damn dime and to please forward any bills they receive to my office. F$%k those assholes.
This post was edited on 5/17/14 at 7:37 pm
Posted on 5/18/14 at 10:01 pm to Scruffy
quote:
An ophthalmologist would probably be able to make more sense of that.
It's really just a bunch of statistics that don't really mean a whole lot to me. There's no way of really saying why these numbers were different. It's not really concerning because ODs don't really do "cataract evaluations" or exams and preoperative testing on patients being considered for cataract surgery. They diagnose a cataract and send it to an ophthalmologist who then determine if the cataract is visually significant, or if there is any other pathology that would make the patient ineligible for cataract surgery. An optometrist will do a thorough exam to look for other pathology too, but I'd never expect an optometrist to perform most of the tests listed in that study.
Actually, if I see a patient with a cataract that wants cataract surgery, I only do glare testing and an A-scan routinely after a complete eye exam. The rest of those tests are overkill for most routine cataract patients.
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