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Thread: Is it worth doing medical optometry?

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    Post Is it worth doing medical optometry?

    Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?

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    Quote Originally Posted by rsOD View Post
    Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?
    Welcome to Optiboard rsOD!

    You will most likely get a lot of response on this post. There are no right or wrong answers. It is really up to you to determine what type of practice you wish to have. Good luck to you.

    The only advice I will offer is if you are going to do medical optometry make sure you bill for it. Do not perform the services and then give them away. Also, if you decide to not perform the services make sure you are referring to someone who will give your patient back to you for routine visits. Don't be too surprised when some of your patients you refer out decide to go somewhere that they will perceive as more full service.

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    Master OptiBoarder OptiBoard Silver Supporter Jubilee's Avatar
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    If you are interested in Medical based optometry, I would suggest contacting NC-OD. He has a successful medical based practice that works in close contact with several clinics as well.

    He can give you the details on how he made it work without being in a multigroup practice.

    Cassandra
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    [quote=rsOD;196367]Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?[/quote
    You should go this way only if you want to make money in our days!

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    Quote Originally Posted by rsOD View Post
    Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?

    rsOD,
    What state will you practice in. Stay out of CA, b/c you won't be able to get on any medical panels.

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    Take it easy on me!

    Ok, I know I may take some heat here.

    I am NOT TRYING to start anything.

    What is the definition of "medical optometry"?

    How does it differ from "optometry"? Is there a few more years of med school? Or is it merely not doing refractions and only seeing conditions that you can prescribe for/treat in your state?

    Please don't beat me up over this. I truly do not know and would like to.

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    Quote Originally Posted by Fezz View Post
    I am NOT TRYING to start anything.

    Uhh huh :D

    I think the OP is trying to say that he wants to go the route of full service optometry meaning everything an OMD does minus the surgery. Including billing insurances for the services such as glaucoma mgmt, post surgery co-managment, etc.

    Most ODs tend to stick to contact lens fitting and refractions. ODs in a medical enviornment setting realize they are an OMD without surgery privilages and run thier practice likewise.

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    Why does an optician say they are a refracting optician. Shouldn't the term "optician" mean automatically that they can refract? Or maybe they are a different breed?

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    Can be great if you are will to invest

    Running a full scope optometry office offering medical services within the scope of your license can be a great way to offer additional services to your patients. We often see pt who have contacted MDs for red eyes only to be told the MD cannot get them in until 4 days later.

    A medical practice, however, requires an investment in equipment you may not otherwise have on hand-newer VF, pachymeter, retinal camera, gdx or hrt type scanner, etc.

    You will also have to be willing to invest staff time in educating pts about the services you provide, getting on insurance co panels, and learning how to bill. You will prob need to spend extra time for CE on disease and meds to stay current. Your staff will also spend time to call on benefits, billing insurance companies, reconciling EOBs, and collecting unpaid portions from pts.

    In order to maximize insurance billing, your fees have to reflect what insurance companies will pay, which is actually more than what alot of ODs charge. Because your are not allowed to charge a different fee for non-insurance pts, your fees will more than likely need to go up. You have to decide what your pt base will allow vs. how much $$ you are willing to forgo in insurance billing.

    Finally, know your limitations. We have advanced cases of glaucoma or other disease that our doc has no intention of treating. She is happy to fill their glasses Rx and let the MD continue treatment. There are specialist for a reason. If the doc doesn't like what she sees, the pt gets sent for a consultation to the appropriate specialist.

    Overall, we are very happy with our increase in medical billing. Our pts love the service, and we get a extra office visit from an existing pt. The increase in fees has not been an issue for pts (OK, one called to complain, but we are not going to do an exam and CL fit for $60 like he got at the big box store:)), and we are seeing a nice increase in revenue.

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    Is it worth doing medical optometry

    Welcome to Optiboard. You will learn alot from this website.
    You should try to practice to the fullest extent of the law in your state. You graduated recently from an optometry school and passed the boards
    in your state so you can treat and prescribe for eye conditions under these laws. You should be able to bill the patients's medical insurance for any eye condition other than a routine eye condition. You may receive much less than billed but that's insurance. Also realize eye pathology is around 10-20% of any optometrist's practice.
    Since you are new in town visit:
    1. all primary care practitioners
    2. all ophthalmologists
    3. all opticians
    Introduce yourself and leave your business cards. Let them know you are available for routine eye care, medical eyecare, and emergency services.
    Best of luck to you in the future and don't listen to FEZZ.

    But don't lose the focus of optometry on correcting refractive errors

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by walleye
    Best of luck to you in the future and don't listen to FEZZ.
    Hands down some of the worst advice you would get, I have gotten more business advice from FEZZ (and all of it made sense) than anyone else on this board. If you een atempt to not listen to Fezz you are doing yourself a diservice as he truly does like to help out and is d*mn good at it.

    Quote Originally Posted by npdr
    Why does an optician say they are a refracting optician. Shouldn't the term "optician" mean automatically that they can refract? Or maybe they are a different breed?
    Not relevent to this thread, get a life.

    Quote Originally Posted by Fezz
    I am NOT TRYING to start anything.

    What is the definition of "medical optometry"?
    I think the definition of "medical optometry" is in order here. I too would like to know how this differs from what an everday optometrists does and if it is no different why was it reffered to as medical optometry. I personaly don't call myself a refracting optician, although I do know how (probably rusty as all get up since I haven't practiced in a long time). If you mean billing medically for services you provide, then h*ll yeah. If you are not it's called leaving money on the table and it is a big no no. Personally our office performs visual fields, retinal photography, and does bill medically when their is a condition, heck it pays real money and it elevates your practice in the patients eyes.

    PS - You mess with the Fezz man and you'll get burned, plus he makes the best beer around these parts. ;)
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    Quote Originally Posted by rsOD View Post
    Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?
    After your investment in time and money, what other route are you considering?

    You can do plenty of searches on this forum to get a decent idea of what various poster's feel about optometry becoming more medical. Interesting reading.

    Might as well use what you are/were taught, and getting paid for it isn't a bad idea either.

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    Quote Originally Posted by npdr View Post
    Why does an optician say they are a refracting optician. Shouldn't the term "optician" mean automatically that they can refract? Or maybe they are a different breed?

    Thanks. That was really helpful.

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    Quote Originally Posted by walleye View Post
    Best of luck to you in the future and don't listen to FEZZ.

    Wow.

    Thats a real kick in the nuts.

    Your the last one that I would expect to say that.

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    A big thanks to braheem24 for clarifying the term for me.

    A REAL BIG THANKS to Harry for his kind words and strong defense on my behalf.

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    HarryChilling,

    It is relevant. If you think that "medical optometry" is such a strange thing, why do the posters ridicule such a designation? Double standard I think and more anti-optometry sentiments. And if you don't understand what medical optometry is, then you should be asking optometrists who "practice" medical optometry what that means instead of having outsiders do that for you.

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    npdr: I don't think any offense was meant at all. Fezz is one of the good guys. Harry is trying to be nice, but don't get him going nuclear.

    This is how I conceptualize it:
    "Medical optometry" is a way of thinking more than anything, not a new way of thinking overall, but it's a new thing for optometry.

    All ODs are able to practice medicine (oh, yeah) as well as optometry, now. The clinicial concepts, office procedures, mission statements all need revision as optometry has changed over time.

    Yes, I think we are at that (phrase I don't like but can't help using) "tipping point" where optometry will adopt the medical model and abandon the optometric model.

    Before, optometry did almost everything different than medicine, since optometry had a totally different philosophy and domain.

    Now, we take orthodox medical histories in medical formats. We structure our examinations in the orthodox medical format. Our cases can be purely medical. Etc., etc., etc.

    The danger for optometry (and opportunity for opticianry) is that there will be a vision care vacuum.



    To the orginal poster:
    I would ask you: what do your patients (prospective patients) want you to practice: traditional optometry only, or traditional optometry plus medicine (i.e. "medical optometry")? Their's is the opinion that matters.

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    Quote Originally Posted by drk View Post
    npdr: I don't think any offense was meant at all. Fezz is one of the good guys.
    Thanks drk!

    :cheers::cheers::cheers:

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    I seriously cannot believe the animosity on this board between OD and opticians.

    I personaly have learned a lot from ODs and find it refreshing to see thier side of the picture. Having worked with OMDs for most of my career I find myself learning more from ODs most of the time.

    Having said that, I dont think Fezz's post was being sarcastic or demeaning in his question.

    Hope we all continue to learn from each other for a long long time :cheers:

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    Quote Originally Posted by npdr
    HarryChilling,

    It is relevant. If you think that "medical optometry" is such a strange thing, why do the posters ridicule such a designation? Double standard I think and more anti-optometry sentiments. And if you don't understand what medical optometry is, then you should be asking optometrists who "practice" medical optometry what that means instead of having outsiders do that for you.
    1. no one said it was a starnge thing - so calm down squirt.
    2. ridicule - maybe an eye exam is in order it looks liek you may be seeing 20/100 (myopic)
    3. anti-optometry - Yes I am, but I did not nor did I see anyone else put that out here.
    4. I didn't know you were the one who decided what to ask and where, so I feel as though getting a more clarified question was very relevent to answering his question
    npdr,
    What a shame 8 years of educations and none of it shows in your posts and look at the pot calling the kettle black, your obvious anti-optician style is weak.

    I forget who said it, but the funniest joke was posted here a couple of months back something about the flees of a thousand camels in someones armpits. I can't help but think of you when I remember that joke.
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    Harry,

    You do realize npdr is a non-dispensing OD, right?

    I really question the original poster... are you a first year? A recent grad? Spammer stirring the pot? If you are a graduating optometrist, what school did you go to where this information was not discussed at extreme length?

    The trouble with opinions on here is that you get some opticians who have worked with a 55-65yr old optometrist who went through a 2yr optometry program decades ago, has not kept up with the times, and refers everything abnormal to someone else. *Some* use this to make assumptions and post on here with strong words about how that is all optometrists are trained to do and should do, morally and legally. And some are a bit more tight-lipped for various reasons. Now, I personally have no problem with these types of optometrists, but rather the thought that all should be limited to whatever the most conservative decides to do.

    I think we can all agree the optician shouldn't be limited to whatever an optician at walmart does. No one comes on here bashing away at opticians who want to solder frames, or deal with prosthetics.

    I'm sure you also will hear about other opticians who say they'd never go anywhere else, but their optometrist is pretty good with medical stuff.

    And others stick up strongly for their office optometrist.

    It all comes down to what you are taught and what you practice. Any optometrist graduating today should be more than capable of dealing with many of the most common eye problems, and associated systemic issues, and diagnosing and referring out whatever is beyond their license.

    In a sense, this happens with many professions. But, especially with optometry there is a wide range of capabilities. Its a shame some choose to make decisions on scope of our practice based off a few examples, or a limited geographic region.

    I'd say on average, just assume ophthalmologists do not value or really understand your education and training in regards to any type of medical care, and opticians *in general* do not value or understand your education and training in these regards either. Like, drk said, in the end it only matters if your patients value and are aware of what you do. This can be the tricky part, and its all too easy to just live with the predetermined assumptions someone makes about you because they remember their optometrist from 30 years ago.

    And I'm not sure the uproar over the other posts. Fezz asked a legitimate question and was most likely looking for honest answers. My answer would be that more and more, medical optometry is becoming "optometry." I think there are still a lot of suckers already doing a lot of these things, and giving it away for free or for 10% of the cost. The other real trick is to stay on your toes with optics, binocular vision, and other areas of optometry that some seem to be avoiding. I think this is a shame.

    Thankfully, its not for them to decide your scope. You have the license and the education (assuming). Do what you want.

    (warning: healthy sarcasm laced sparingly throughout post)

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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by orangezero
    You do realize npdr is a non-dispensing OD, right?
    I do it was mentioned in previous threads, but I'm fresh out of cookies. :D

    Quote Originally Posted by orangezero
    The trouble with opinions on here is that you get some opticians who have worked with a 55-65yr old optometrist who went through a 2yr optometry program decades ago, has not kept up with the times, and refers everything abnormal to someone else. *Some* use this to make assumptions and post on here with strong words about how that is all optometrists are trained to do and should do, morally and legally. And some are a bit more tight-lipped for various reasons. Now, I personally have no problem with these types of optometrists, but rather the thought that all should be limited to whatever the most conservative decides to do.
    Actually no one, but you brought this up, but it's a valid point non the less.

    Quote Originally Posted by rsOD
    Hi,
    I am a new optometrist and was wondering what other practitioners felt about medical optometry and what advice would you have for me if I were to go this route?
    Orangzero,

    It wasn't the original poster that wanted a definition, but an optician that was trying to reply. Our office performs and bills for anything medical and heck yeah I say go for it, but does that make our doctor a medical optometrist? Heres a question if an OMD performs a Visual Field and bills for it, is he practiceing "medical optometry". The term medical optometry is a new one to me and obviously new to others here as well, it would have been nice to get a definition to what would be considered medical optometry.

    Definition of Medical Optometry - Medical procedures performed by a optometrists.

    I personally thin kthe original poster was trying to ask a question better than the one he did and that's should one promote and bill medical procedures in their practice? Now thats a heck yeah.

    PS - the joke was, "may the flees of a thousand camels infest your armpits." Maede me spit soda through my nose when I first heard it, anyway I'm thinking of you npdr.
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    Big Smile Welcome to the insane asylum . . . !!

    We hope you enjoy your stay. There are a couple of Drs here in Colorado that are doing quite well by doing things other than spinning dials. Two have hooked up with an OMD and are billing whizzs. As somebody mentioned you have to charge for everything and have to bill appropriately. The other has a loose alliance with several OMDs and she has a solo practice. Very smart woman and a very good Dr.

    Good luck to you!!

    :cheers:
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    ATO Member HarryChiling's Avatar
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    Quote Originally Posted by Framebender
    welcome to the insane asylum
    Don't get too close to the opticians cage they bite. ;)
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    I did read it all :)

    Its a complex issue and everyone has a different take on it.

    Most states do not allow or qualify specialization within optometry. So, the idea of medical optometry is a bit strange, and somewhat unnecessary. I believe there are some states with rather strict rules about certain medications such as steroid drops, or glaucoma management, but don't think it requires a new title.

    I think if you ask most recent grads what they are doing it would be, "I'm practicing optometry" not " I'm one of those medical optometrists."

    My earlier point was that there is a good variety of scope from OD to OD.

    Our CE is mostly concerned with glaucoma, allergies, cataract co-management, amblyopia, strabismus, retinal pathology, ant. seg disease. Frankly I'm unclear how one can be a licensed optometrist in todays climate and not feel they are at least a little "medical." Doesn't mean thats what the majority of ODs are mostly doing day in and day out, but it does point out the general direction of optometry.

    But back to the original questions. In this day and age there are very few realistic avenues in which you can avoid the medical aspect of optometry. Sure, you could specialize in low vision, or teach in a school and deal with one specific issue not related to medicine, or focus on vision therapy. However, for a new grad to get out and think, "should I treat this allergic conjunctivitis or not...?" "should I send this patient out because I think he may have a corneal ulcer?" Shouldn't happen.

    But still there are some older ODs who have not adopted this philosophy for a variety of reasons. Often its as simple as not being able to get reimbursed for it, or because they are only 5 years away from retirement, or because they do just fine in their area without it. But, optometrists have been allowed on medicare for over 20yrs now, which only allows for reimbursement on medical issues.

    So, again, to clarify, the medical optometry designation is a bit redundant and unneeded. And I hope to not be too hard on the older optometry community. Most have kept with the expanding scope of the field of optometry and are continuing to learn more and more each year. But thats really true in most professions. I doubt chip knew much about progressives or AR or transitions when he started working in 1894 (this is very much a joke :o).

    I agree with you though, perhaps the original poster will bother to reply with a clarification.

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