Originally Posted by wmcdonald
i'm with this guy!!!!!!!!!!!!!!!!
i'm with this guy!!!!!!!!!!!!!!!!
A difficulty we encounter on literally a daily basis is clients who believe they've been examined by an ophthalmologist (MD) when actually they attended an optometric practice. In past times it was required for an optometrist to identify themselves as Dr. Soandso, Optometrist, (or, OD) with the Optometrist an integral part of their professional title. But, no longer it seems this is necessary. To the general public, a physician is a medical doctor. Period. Working in a long established optical dispensary with long-time clientele we are constantly called upon to explain the difference between the two. we've recently noted the explanations offered by many optometrists on the scope of practice differences blur the lines between the professionals to the average layperson.
I think this is because the lines between the two professions (optometry and ophthalmology) have infact blurred, and continue to do so.
if you look at a place like washington state, optometrists (or optometric physicians) have had tpa rights for a long time, and are able to diagnose and treat glaucoma. what is the definition of a physician anyways?
if you look at how hard it has become to get into optometry school and how the curriculum is now laid out, you'll see that its been modelled after and now closely resembles medical school.
In my practice, the shingle on the door says SoAndSo, O.D., the stationary says the same, my labcoat says the same. Nowhere in the office does it say "Dr", but people tell me time and time again, "This is the best exam I have ever had", and most of the time, I haven't even gotten past taking visual acuities. At least half of the time, they are former OMD patients. An eye exam is an eye exam. It doesn't matter who does it. Anything short of a complete thorough medical-functional exam, no matter who is doing it, is cheating the recipient.
Many optician posters on this forum would agree that an OD is going to write a more accurate, fillable Rx. Why is there still the perception that the OMD should be put on a pedestle, and classified as being "better"? Could it be because the OMD is more likely to write an Rx that gets filled by an independant optician? C'mon people...We all do things to promote our best interests. Bottom line is though, if you deceive the patient, even if it is by giving a slanted view of what the definitions of the three O's are, the patient is going to SEE (no pun intended) right through ya.
Listen...in my practice we have four licensed opticians. Half of our patients call them doctor, even though they wear a lab coat that says Optician. Do we put up a sign that says "An optician is not a REAL DOCTOR"? Of course not. Do we provide the best eye exams and eyewear? You betcha. And if somebody wants to misinterpret this as...trying to be like an OMD...that's their problem.
Last edited by fjpod; 12-10-2008 at 08:57 AM.
The preception presists because OMD's used to believe that having a financial interst in dispensing was uneithical. Most OMD's with a dispensary attempt to disguise thier interest in dispensaries when they have one by having it ... down the hall, or down on the first floor and placing the stock in family members names.
While OMD's appearentlly no longer believe in ethics at least were profits are to be derived.... The public and some dispensers still believe they are more likely to be able to get thier Rx out of the doctor's office with an OMD. Obviously independent dispensers used to be able to derive a living (sometimes a good one) from the support of OMD's almost exclusively. Patient's still have the preception that a medical doctor would never prescribe anything for any reason other than for the patient's benefit (for shame the thought that he would prescribe something because he might make money off of it.)
Now there was never such a preception in O.D. practice and in the past some things that could be described only as "cult medicine" were attributed to O.D.'s.
So history has a lot to do with these presceptions and I suppose that by cleaning up one's act and making sure that others of your discipline do same, might in time equalize the presception. But for now it lingers.
Chip
It's interesting, Chip, to hear how things were during your prime in the great State of Mississippi. Thanks for the history lesson. Amazing how things have changed down there.
To make an assumption that an MD would always make the ethical choice , as opposed to others such as ODs, Opticians, Dentists, etc., is ludicrous. The only reason OMDs traditionally gave out their prescriptions for opticians to fill was because there was little profit in it compared to what they could earn from surgery. They didn't do it because they were "ethical".
Today with market forces being what they are in the healthcare industry,... with decreasing insurance reimbursements for surgical (and every kind) of procedures, with encroachment of OD scope of practice, etc., I honestly don't feel they are providing eyewear because they feel there is a huge profit in it. I think they do it to hold onto their market share of patients, especially those in need of surgery. You know, many independant opticians have hired ODs so they could provide full scope care under one roof. This was a threat to ophthalmology because it stole exam patients. So blaming the OMDs for independant opticianry's decline is one-sided thinking. Just as independant opticians want to hold onto their market share, the OMDs (and ODs) want the same. Nothing wrong with that. Nothing unethical with that.
And why is there still the assumption that someone who prescribes and dispenses their own eyewear is automatically unethical, but someone who finds "cataracts" and takes them out him or herself is not? If some on this forum don't wake up and realize that there are good and bad on all sides, they are doomed to failure.
Two things in closing...
1. Bates was an ophthalmologist.
2. Keep your friends close, but keep your enemies closer.
Don't take the bait, fjp.
There should be no bait, this was a great article where the person articulaed the EXACT problem with the profession of opticianry. I guess from teh outside it's easier to look in and see that the water is poluted, but from within we're still ignoring the fact that the problem is ours and ours alone. Amazing how quickly this discussion went off topic and to hateful place. I read a lot of stuff and all or any of it can be misconstrued in 4 pages worht of posts to eventualy end up as OD's hate OMD's haet Opticians hate the world. If you looked at teh history of the professions you can se where this all started and you'd be amazed. Our problem now is that the cleanup is going to be dificult because we are taking too long to address it, so the alternative is to blame the world.
PROBLEM: OPTICIANS HAVE TEH SMALLEST STAKE ON THE FIELD AND ARE AT RISK OF EXTINCTION.
SOLUTION: MAKE OURSELVES MORE VALUABLE AND INTEGRAL.
Many ways to accomplish this, licensure, education, etc. It all starts and ends with personal development.
Meant Chip-bait.
I guess there is a sucker born every minute.
Come on you guys, you asked a question and I gave you a history of why things are. No opinions or hate, what's your problem?
Chip
The term "cult medicine" in reference to optometrists can only be attributed to organized ophthalmology's PR campaign against ODs.
Why would you be in on the campaign against ODs gaining the rights to do the things they need to do as primary care providers?
BTW, as you said, this was a non-negative thread - until you had to bring up the "hate" (as you put it).
And to expand on fjp's point - actually it is SO unethical for a provider to refer to themselves for surgery that it is forbidden by law for an OD to have even partial ownership in a surgical clinic; even though they wouldn't perform the surgery. But it's OK for the MD to own it, and self-refer, and perform the surgery. That's fine by me, but if it's good for the MD, then it should be good for the OD (who would have much less incentive and opportunity to put their own best interest ahead of the patient)
Yea, I know, I took the bait. But it's just so tempting.
Last edited by MarcE; 12-10-2008 at 11:12 PM.
[quote=wmcdonald;275661]
It has nothing to do with length. You seem to feel that everyone is attacking your program, but it is not meant as a direct affront, I assure you. Uniformity means, from my perspective, that an Optician in Mississippi, NY, NC, Florida and all other states should have the same education/training/background. For us to be accepted across the country, it is completely necessary.
No, I take it as an indirect affront.
Uniformity as in the recent TEXAS slogan 'Raise the Bar'... make an A.A.S. mandatory yet they can't get enough Texas support for a petition. It reminds me of the joke...
Ask an Optician if ignorance and apathy exists in our profession. They will answer, "I don't know and I don't care".
I do consider the word 'uniform' or 'uniformity' an affront to my (your words..."overly shortened") 6-month program. Yet substitute the word 'effective' for 'same' as in "all other states should have 'effective' education and training and one would be hard-pressed to find fault.
And what do you mean by the same background??? Keep out visible minorities/ people that can't/won't spell correctly?/ recent immigrants?? what??
NY at one time had the toughest test where you had to sit for 3 days of testing. One test was given at 8:00 am till noon then from 1:00 pm to 4:00 for three days. Six tests in all with each one covering 100 questions each from Geometric Optics to Anatomy of the eye. Then on day four you had the practical from 8:00 am to 12:00 noon. So ya the ABO is a MICKEY MOUSE EXAM!
In NY, refraction by a tech is illegal. No one can be delegated a task for which a license is required, according to NYS law. That's not to say that techs are not doing it all the time. The M.D.'s THINK they can delegate, and in many states they can, but not in NY. So why do so many offices have techs refracting? Because no one complains! Our Office of Professional Discipline will only respond to formal complaints. They do not go out and police the field. Medical consumers are ignorant of the laws regarding professional practice, and cohort-practitioners won't roil the waters.
If the federal govt. does not regard refraction as a medical issue (remember, Medicare will not pay for it), then why should we not refract? At least allow it under OD or MD supervision. That would legitimize reality for the techs, and open an opportunity for opticians working in OD/MD settings. ABO/NCLE actually has a written refraction certification exam that has been waiting in the wings for over 6 years. It could be used by any state, in combination with a practical exam, to certify opticians and techs to refract under supervision. OK - nuff said!
Take it any way you like, and substitute any word you feel appropriate. It is not about you and your school. I am sure that surprises you, but this issue has absolutely nothing to do with you in Canada. It is what is necessary, from my perspective, for Opticians in the US to improve their status. An example is Optometry. They have the same, or at least similar, education and training in every jurisdiction of the country. They also have required clinical work, and have the similar professional backgrounds any where. We can also learn from Canada. Your Opticians are way ahead of us in education and training. While it is not the same, it is at least required! Background has nothing to do with minorities, or proper spelling, but professional background, which I feel was clear to most. Until we can agree on what shape we need to take in the US, we will not gain ground. Many disagree, and feel change is not necessary at all. I disagree, and feel we need education to advance.
Last comment on this subject from me.
[quote=tmorse;276064]
It has nothing to do with length. You seem to feel that everyone is attacking your program, but it is not meant as a direct affront, I assure you. Uniformity means, from my perspective, that an Optician in Mississippi, NY, NC, Florida and all other states should have the same education/training/background. For us to be accepted across the country, it is completely necessary.
No, I take it as an indirect affront.
Uniformity as in the recent TEXAS slogan 'Raise the Bar'... make an A.A.S. mandatory yet they can't get enough Texas support for a petition. It reminds me of the joke...
Ask an Optician if ignorance and apathy exists in our profession. They will answer, "I don't know and I don't care".
I do consider the word 'uniform' or 'uniformity' an affront to my (your words..."overly shortened") 6-month program. Yet substitute the word 'effective' for 'same' as in "all other states should have 'effective' education and training and one would be hard-pressed to find fault.
And what do you mean by the same background??? Keep out visible minorities/ people that can't/won't spell correctly?/ recent immigrants?? what??
Fairly Sure that M.D.'s can deligate anything they want (with of course being liable for same) federally. At least many MD's have told me this over the years.
Chip
The NY Office of Professional Discipline doesn't see it that way, and I don't know if Federal law trumps State law (although I'm told it only does when there is no State law addressing the subject). Most of the doctors I work with think they can delegate anything - dilation, administering drug, refraction, etc. until they investigate it with NYS. When they find out they can't - they still do it! Noody challenges them. Probably a good thing. It would open up so many worm cans, and could backfire on opticians and their scope of practice, which is quite liberal here.
Sharron B:
You have it backwards, Federal Law trumps State Law (not always a good thing but that's the way it is).
Thanks. I stand corrected. You may not have seen my updated post above indicating what you have said. That practical still knocks out about 50% of the test takers, I am told.NY at one time had the toughest test where you had to sit for 3 days of testing. One test was given at 8:00 am till noon then from 1:00 pm to 4:00 for three days. Six tests in all with each one covering 100 questions each from Geometric Optics to Anatomy of the eye. Then on day four you had the practical from 8:00 am to 12:00 noon. So ya the ABO is a MICKEY MOUSE EXAM!
Can't argue with anything you said.
In NY, refraction by a tech is illegal. No one can be delegated a task for which a license is required, according to NYS law. That's not to say that techs are not doing it all the time. The M.D.'s THINK they can delegate, and in many states they can, but not in NY. So why do so many offices have techs refracting? Because no one complains! Our Office of Professional Discipline will only respond to formal complaints. They do not go out and police the field. Medical consumers are ignorant of the laws regarding professional practice, and cohort-practitioners won't roil the waters.
If the federal govt. does not regard refraction as a medical issue (remember, Medicare will not pay for it), then why should we not refract? At least allow it under OD or MD supervision. That would legitimize reality for the techs, and open an opportunity for opticians working in OD/MD settings. ABO/NCLE actually has a written refraction certification exam that has been waiting in the wings for over 6 years. It could be used by any state, in combination with a practical exam, to certify opticians and techs to refract under supervision. OK - nuff said!
You are absolutely correct. NYS law does prohibit anyone, including an OMD from delegating refraction...but it is completely ignored, and NYS OPD refuses to enforce it. NYS law also forbids an OD from having an office assistant (or even a trained ophthalmic tech or an optician) put drops in someone's eyes under supervision. Because there is no legal opthalmic tech profession in NY. On any given day, you can find a few Ophthalmic Tech Wanted Ads in the NY Times. This too is also ignored.
There is no Federal law that says an MD is allowed to delegate anything they want to. Some practitioners just think they are above the law.
Now look, this was a positive thread about opticians perhaps gaining more education and possibly expanding scope, and it was written by an OD that dislikes narrow-mindedness...but SOMEBODY keeps interjecting misinformation, innuendo, and subject matter that is not even related to the issue.
Last edited by fjpod; 12-11-2008 at 05:10 PM.
I hate it when I agree with you. :p
Sometimes you have to grin and bear it! :bbg:
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