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Thread: Breaking News in the Great Glasses Court Case

  1. #51
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    Quote Originally Posted by Excalibur View Post
    Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.
    Bad comparison. Doctors are already prohibited from selling the meds they prescribe, but optometrists do make a profit from selling the same eyewear they prescribe.

  2. #52
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    Indeed. And surgeons often recommend the surgery they may perform.

  3. #53
    Master OptiBoarder mike.elmes's Avatar
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    Why is it that a lisenced Optician can't work as a dispenser for an Optometrist in Ontario, is it against the Optometric regs or the Opticians regs??

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    I think the concern that optometrists have about a refraction performed without a full oculo-visual exam arises from the many patients that we see who have undiagnosed pathology, either ocular or systemic, who are asymptomatic, and are correctable to 20/20. Often these patients present for an exam simply because they want a new eyeglass Rx or CLs. If these patients have a sight test, they will go on their merry way with undiagnosed disease that could be sight threatening, or possibly even life threatening. Is this an acceptable situation?

    JP

  5. #55
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    Last edited by Refractingoptician.com; 03-02-2007 at 12:49 AM.

  6. #56
    Master OptiBoarder mike.elmes's Avatar
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    Quote Originally Posted by Excalibur View Post
    "1) Why pay for an eye examination, when all one really wants is a new pair of glasses or contact lenses? As an adult, in a democratic society, why should I be forced to pay to see clearly? If I choose to only get a new prescription, then why should anyone object? When did my prescription for sight, become part of an examination for my eye? They are two totally separate things."

    ---------------

    The recent decision by Justice Crane in the Ontario Superior Court was able see through arguments that a refraction could or should be separated from a complete ocular assessment, a position that is wrongly echoed by some optical retailers.

    Perhaps it's time the government permitted birth control pills to be obtained in vending machines too? Is it really necessary for sexually active women to have PAP smears? Of course not (and I say so sarcastically).... cervical cancer is rare. The problem is that in essence, a patient (or in the case of an optical dispenser... a 'client') "doesn't know what they don't know".

    For a century, the optical professions have tried to move from the back of jewelery stores only to have some try to separate a refraction from a comprehensive assessment and push that 'procedure' to the back of an optical shop. How unfortunate.
    Many clients wish to have an Optician duplicate an older rx that they deem to be satisfactory to them for acuity. The CONSUMER HAS A CHOICE.....Just as the consumer should have a choice about an eye test or eye exam. It's available all over the world, and in Alberta and BC. The consumer shoulders the resposibility of their decisions. The government can't mandate something they don't pay for. At the current rate of inflation, how long will it be until the comprehensive eye exam will cost 125.00?? I am not saying that this level of care is not worth that , but the consumer is not looking to get a fully comprehensive eye health workup each time their eyes need a change of prescription.
    In a dispensary in Edmonton, not far from here, a fellow Optician is sent patients from an nearby Ophthalmologist, to do retinal photography. The results are sent back to the doc for analysis. He also does corneal topography for his contact lens patients and has his own eyelogic system. This represents the future of Independent Opticianry for those who care to specialize and expand their scope of practice. Perhaps Optometry will have to separate the refraction to offer a less expensive service to the public if such a niche is to be created.
    Last edited by mike.elmes; 12-08-2006 at 08:02 PM.

  7. #57
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    Quote Originally Posted by Dave Nelson View Post
    Bad comparison. Doctors are already prohibited from selling the meds they prescribe, but optometrists do make a profit from selling the same eyewear they prescribe.
    Dave,

    The clarification offered by Exalicur in response was to clairfy the rationale that a prescriber, be it an MD or OD, should not be directly employed by those filling the prescriptions (RPh/pharmacy or RO/optical corp.) due to possible interference of the employer in clinical decision making.

    The issue you raise is on the oppossite end of the issue. However, it is not uncommon for health providers to profit from the services and products they recommend. Do you not profit from the glasses and contacts you prescribe to clients based on a sight test?

    In the past in Ontario, the college of optometrists prohibited OD's from having direct relationships with optician. However, there is a draft policy change that will allow OD's to employ opticians, but the ministry has decided to study all health conflicts of interests before approving any new changes by the colleges...

  8. #58
    OptiBoard Professional Ory's Avatar
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    A little more history on the situation in Ontario. Quite a number of years ago there was a gentleman in charge of the college of optometrists who got a little too excited about the idea of "protecting the public" and put into the regulation the above mentioned restriction of opticians not being allowed to work for optometrists. He is also the reason we sell on a dispensing fee model and cannot advertise.

    As we all know, once something is on the books, it is tough to change. The college has been sending around the draft change to the conflict of interest regulation for months now....it's getting tiresome receiving a new copy every month or two with little changed. But that's beside the point.

    The result of this is quite frustrating. I've worked in an office that hired an optician who let her license lapse in order to be employed. I've seen many offices that hire opticians on the sly....normally OK until you get a competing office ratting you out. Now people don't seem as concerned...there's an office in my town that has put the name of their optician on their letterhead, complete with R.O. after his name.

    Believe me, no one will be happier to see some of these regulations changed than the optometrists in Ontario.

  9. #59
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    I agree with Ory's comments about how many Ontario ODs would be very happy to hire a licensed optician if the regulations did not stand in the way.

    I wonder, however, if an optometric practice may do better by hiring trainable (unlicensed) staff who could assist the optometrist in dispensing and do so at a much lower rate/hr than hiring an optician.

    I am now putting on my flame-resistant suit!:angry:

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    Correcting your errors

    There is nothing prohibiting an OD from hiring an RO. I know of a few practices that do so.

  11. #61
    Excalibur
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    My understanding is that in Ontario, an OD cannot hire a licensed optician. If someone can cite evidence to the contrary in legislation, please post to the list.

    Having said that, what is the salary range for an optician in Ontario?

  12. #62
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    I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
    Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)

  13. #63
    OptiBoard Professional Ory's Avatar
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    Quote Originally Posted by Caddy View Post
    There is nothing prohibiting an OD from hiring an RO. I know of a few practices that do so.
    Correcting yours:

    (4) It is a conflict of interest for a member to,
    (e) engage in the practice of optometry in association, partnership or otherwise with or while employing or under the employment of a vendor of ophthalmic appliances or an ophthalmic dispenser registered under the Ophthalmic Dispensers Act or with any other person or corporation other than,
    (i) with a member who is engaged in the practice of optometry,
    (ii) with a legally qualified medical practitioner who is engaged in the practice of medicine provided that such practice is not inconsistent with Part V of the Act or regulations or by-laws,
    (iii) as an employee or agent of a municipal or other government, agency of a municipal or other government, a university, hospital,
    (iv) with a community health centre if the employment or any arrangement has been approved by Council, or
    (v) with a corporation for the sole purpose of providing optometrical counsel and service to the employees of the corporation; or
    (f) own or financially benefit from the operation of a company, firm or business that manufactures, fabricates, supplies or dispenses ophthalmic appliances. R.R.O. 1990, Reg. 550, s. 26 (4).
    In other words, an optometrist may not work with or for an optician.

  14. #64
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    Good heavens Gregory, it's 11:30 in Ontario. Shouldn't you be getting to bed?

  15. #65
    OptiBoard Professional Ory's Avatar
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    Worst part is I have a 1-day LASIK follow up tomorrow morning. Also my wife's due date. Will likely be a busy weekend!:cheers:

  16. #66
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    Keep us posted on that big day. (I mean the baby, not the lasik check.):cheers:

  17. #67
    ATO Member HarryChiling's Avatar
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    I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

    I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

    The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

    Now you can crucify me.
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  18. #68
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    Thanks for the post. That clarifies the issue.



    Quote Originally Posted by Ory View Post
    Correcting yours:



    In other words, an optometrist may not work with or for an optician.

  19. #69
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    Dave,

    One of my best assistants is Rocco. He's been working in my office for 8 years, and I'm pretty certain he doesn't wear a pink thong. He's got a couple of blue tatoos. In fact, he'd probably give you a black eye because when he reads your comment he'll sure being seeing red.

    If the law allowed me to hire an optician, I probably would. To date, I've done very well hiring trainable staff who work with me and the patient. We dispense over 80% of the patients who are in the office and require eyewear changes. No 'arm-twisting' tactics required-- just competent service, reasonable fees, great reputation in the community and a lot of referrals from satisfied patients. I don't think my patients have been harmed by having unlicensed staff. My staff and I rarely make lens rx/dispensing errors including 'upside down' PAL rxs.

    We are also busy because our patients, family docs, several endocrinologists and OMDs send us new patients. They advertise our practice for us. Are we greedy? Sure! and... we take our jobs seriously but we don't take ourselves seriously.:bbg:


    -----------
    Quote Originally Posted by Dave Nelson View Post
    I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
    Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)
    Last edited by Excalibur; 12-09-2006 at 06:45 AM.

  20. #70
    Excalibur
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    Most ODs don't disagree with trained technicians doing refractions within the confines of an ophthalmic practice where at least the refraction has been performed as part of an overall ocular assessment. I believe all ODs (and a lot of MDs.. and drum roll please... opticians too) do not agree with opticians stand-alone refractions.

    You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations. That's greed? Really.
    Your comment that optometry is a greedy is not only nonsense, but just plain asinine.

    ------------

    Quote Originally Posted by HarryChiling View Post
    I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

    I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

    The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

    Now you can crucify me.

  21. #71
    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    Quote Originally Posted by Excalibur View Post
    Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.
    So you don't have the whole "minute clinic" deal springing up all over Canada?

    Here in the US many pharmacies have nurse practicioners (who can prescribe meds) located within their businesses to offer routine low level care... such as treating respiratory infections, sore throats, flu, infections..etc..

    So much for that separation....
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  22. #72
    OptiBoard Professional Ory's Avatar
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    Quote Originally Posted by HarryChiling View Post
    Now you can crucify me.
    Harry,

    I have a lot of respect for your knowledge. You consistently post reasonable, well thought out comments.

    In this case, I take exception to 2 items. The first is labelling all optometrists as greedy. I think most people who know more than one or two of us will find that to be the exception rather than the rule. I could easily say opticians are all lazy and uneducated based on one or two I have met, but I''m well aware that isn't the case. So please stop with these insulting blanket statements.

    The second issue I have with your post is stating that without refraction there would be no need for optometrists. You are of course entitled to your opinion, and I'm sure I won't be able to change it. In the area I work in we have a shortage of ophthalmologists. Optometrists refract, assess binocular vision (something no one else does), perform minor procedures (punctal plugs, foreign body & rust ring removal, etc). Once the Ontario government gets its act together we will have the best pharmaceutical privileges in the country. Currently I just request the appropriate meds from the patient's GP, most of whom understand that I know what I'm talking about. So basically, I provide primary care. There is no need to see an ophthalmologist for much short of surgery, of which there is enough demand that everyone is happy.

    I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.

  23. #73
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    Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

    My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.

  24. #74
    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Ory
    You consistently post reasonable, well thought out comments.
    I really try to stay out of these discussions, but what happens is everytime their is a discussion about the subject it seems that all the optometrists that post have the same canned response. This usually gets me froathing around the lips and all of a sudden I have said some stuff, I probably should not have said. I know that optometrists do have a place in the whole system and will probably always be the bioggest role, but the whole belitlle another profession to make ones own profession just gets old.

    Quote Originally Posted by Excalibur
    You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations.
    This quote of yours reminds me of an old expression "look at the pot calling the kettle black". You must be upset that you can't charge more. $$$, it's not fair.

    Quote Originally Posted by Ory
    I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.
    Absolutely you will be OK, if you embrace the change what will happen is these opticians will be refering their patients to you for various reasons, opticians can be your greatest ambassadors. I think that the change creates fear and this is what leads to the unrational thoughts, both on my part and on some of the optometrists that post whenever this subject comes up. I always make it a point to make my opinion be know on this subject, because it will only make my position stronger the more I debate on it. I have consistently seen optometrists argue their point about this subject untill they are blue in the face and their position only gets stronger, if I can empassion one optician to try and make change the tides will turn. No offense meant to anyone, but if you lay in front of a tank you get run over. ;)
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  25. #75
    Excalibur
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    Of the 3 "O's", optometry has had the greatest success from a legislative perspective across North America. Optometry is a 'centrist' profession, meaning it provides the widest breadth of diagnostics and treatment modalities for the vast array of ocular anomalies. This has created some marginalization of opticianry and ophthalmology. It is, however, important to recognize that each of the professions does have it's strengths.

    If adults believe that the best interests lie in providing free-standing 'refractionaries', then perhaps this should be made a part of the federal government's election platform. And yes, "patients don't know what they don't know" ... I see this all the time in my practice when I (and my colleagues) diagnose asymptomatic eye disease. As you know, the eye does not have a sophisticated 'early warning system'.... and regular ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say.

    ---------

    Quote Originally Posted by shawn b View Post
    Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

    My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.

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