re: Are we sure optometrists should do eye surgery w/o going to medical school?

Wait you want patients who need an eye surgeon because their vision is suffering to "look for the MD letters." What if the patient cannot see the MD letters? What if the patient is a child or a prisoner? Or a neonate? What if we just had med school grads do surgery like they do in Texas and Mississippi and Arkansas and America?

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well, i assume . . .

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Just STOP!

Please!

You "arse-U-Me"?

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i'd expect such mistakes to be vanishingly small for both.

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Why? What are you basing this on? I know not real data since there is none (that I could find at least). But why would you expect that a person who has not been specifically trained in eye surgeries, or surgical techniques in general, has a "vanishingly small" complication rate? You already correctly acknowledged that ophthos have a non-zero rate, and thats after intensive training for years. Yet optometrists would have a similar rate despite not being trained for this? I'm perplexed by your reasoning.

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What are you basing this on? I know not real data since there is none

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unless the claim that this has been done in other states is false, i'd call the fact that it's being considered with potential for success in other states a bit of meaningful data right there, for reasons such as the scenario the YipSkid poster said.

(i know you said you couldn't find info on those other states. it was true that other states are doing this though, right?)

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But why would you expect that a person who has not been specifically trained in eye surgeries, or surgical techniques in general, has a "vanishingly small" complication rate?

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honestly, an assumption that the procedure in question is relatively simple and not terribly dangerous. otherwise, i wouldn't expect lower-level providers to try to do it and still seek to be insured. is that unreasonable?

I can tell ya this. I'm not letting any optometrist operate on MY orbs.

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I'll help you out here 90pp. Optometrists have 4 years of school post undegrad. Ophthos have 4yrs of med school, a transitional year, and then 3-4 yrs of residency, plus another yr of fellowship if one so chooses. You think those extra 4-5 yrs (in addition to the intensive medical school training) make an insignificant contribution to their ability to perform these surgeries?

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thanks.

but i DID know this just from reading about them. i thought y'all were alluding to something really in the weeds

that's why i was letting NCT berate me about being insulting or whatever. man, frick this thread

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unless the claim that this has been done in other states is false, i'd call the fact that it's being considered with potential for success in other states a bit of meaningful data right there, for reasons such as the scenario the YipSkid poster said.

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No, thats not meaningful unless data shows complication rates are similar. Other states could just be trying to adapt it because it has saved said states money up to this point. If there are more complications and secondary surgeries because of that, this savings will sure be cancelled out.

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(i know you said you couldn't find info on those other states. it was true that other states are doing this though, right?)

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KY and OK I believe. Not sure these are exactly states we should all follow

And I found a couple interesting stories while googling:

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Dr. Parke's experience included treating a man whose "skin tag" was excised by an optometrist. Nine months later the patient came to the university medical center with an invasive, substantive squamous cell carcinoma that required a massive reconstructive surgery. "We asked the patient, 'Why'd you let him do that?' He replied, 'Well he's a doctor, he had on a white coat and he said he could.'"

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In another case, an elderly patient with severe end-stage glaucoma could only be controlled surgically through a technique called filtering blebs. "She went to an optometrist who said to the patient, 'Mrs. Jones, you have cysts on your eyes, I should take care of those now,' and he proceeded to excise them, completely undoing the surgery."

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I know these are just csb's, but without data, just saying "its implemented and other states are trying to do the same" is not really a convincing argument if alot of these types of things are happening.

And this quote from the same article says what I've been trying to say quite elegantly:

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There's a reason the rest of medicine organizes itself into cardiologists and cardiovascular surgeons, neurologists and neurosurgeons, and so on. There's a reason you want a surgeon to do surgery. They do a lot, and they do it well. It's worth a little drive.

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Exactly. Surgery is a whole different ball game. You could know every single little thing about the heart (cardiologist) but still not be even remotely qualified to do heart surgery.

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honestly, an assumption that the procedure in question is relatively simple and not terribly dangerous.

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Who determines this? When you are dealing with something as delicate as the eye, things can go wrong if you don't know exactly what you are doing.

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theunknownknight

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Thanks for the link.

Obviously that study is outside the scope of this discussion since there wasn't a study re: surgeries specifically. Sure, optometrists do go through 4 years of training so they should be able to dx and manage a plethora of eye pathologies. But thats different that being able to perform eye surgeries. Kind of like the cardiologist vs the CT surgeon.

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theunknownknight

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did read the summary results and stuff. how relevant would the practitioners/ grad-students in the thread say that comparison was for these particular procedures? seemed quite general to me

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I think part of "good info" is knowing whether this person has been board certified to do this operation by experts in the field and has gone through years of training to do so. You do realize a very large chunk of this country doesn't even know what the difference between an ophthalmologist and an optometrist is? I'm all for making your own mistakes and learning from them, but I don't believe ignorance should cost you your vision in this situation.

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i'm certainly convinced that the issue may be more complicated than simple rent-seeking.

that said, the downside of what i think your position may be is that we potentially deny the service to many people of lesser means/ coverage, while potentially somewhat overcharging several others.

perhaps the solution would be some type of practitioner disclosure requirement for the lower-level guys (the optometrists) that bordered on over-the-top, so there was no way even a dumbass could make the transaction without understanding the difference in qualifications? that would seem preferable to me over simply taking the choice away completely