OD vs OMD

[DragonLensmanWV]

They're at it again, folks. Here there is Senate Bill 230, which seeks to expand the scope of Optometry here. Of course, any new procedures will have to have it's practitioners certified in their abilities before performing any of them. Years ago, the ODs wanted to use TPA durgs to dilate, etc. At that time several OMDs took to the floor of the Legislature, one said that because of the new laws, ODs would be treating diabetes and "people would be dying in the streets!" It passed and no one died in the streets.
Now they want to perform a few more procedures, involving injections, foreign body removal and a few of the simpler laser procedures. Once again the OMDs are using the tactic of fear, their ads stating Lasers Burn and Vaporize Tissue That Can Never Grow Back type of ads.
Here's the critical part of Scope of Practice.

Any comments?

§30-8-9. Scope of Practice.
(a) An licensee may:
(1) Examine, diagnosis and treat diseases and conditions of the human eye and its appendages;
(2) Administer or prescribe any drug for topical application to the anterior segment of the human eye for use in the examination, diagnosis or treatment of diseases and conditions of the human eye and its appendages: Provided, That the licensee has first obtained a certificate;
(3) Administer or prescribe any drug from the drug formulary, as established by the board pursuant to section six of this article, for use in the examination, diagnosis or treatment of diseases and conditions of the human eye and its appendages: Provided, That the licensee has first obtained a certificate;
(4) Administer epinephrine by injection to treat emergency cases of anaphylaxis or anaphylactic shock;
(5) Prescribe and dispense contact lenses that contain and deliver pharmaceutical agents and that have been approved by the Food and Drug Administration as a drug: Provided, That the licensee has first obtained a certificate and satisfied all requirements as set out in legislative rule;
(6) Prescribe, fit, apply, replace, duplicate or alter lenses, prisms, contact lenses, orthoptics, vision training, vision rehabilitation;
(7) Perform the following procedures:
(A) Remove a foreign body from the ocular surface and adnexa utilizing a non-intrusive method;
(B) Remove a foreign body, external eye, conjunctival, superficial, using topical anesthesia;
(C) Remove embedded foreign bodies or concretions from conjunctiva, using topical anesthesia, not involving sclera;
(D) Remove corneal foreign body not through to the second layer of the cornea using topical anesthesia;
(E) Epilation of lashes by forceps;
(F) Closure of punctum by plug; and
(G) Dilation of the lacrimal puncta with or without irrigation;
(8) Furnish or provide any prosthetic device to correct or relieve any defects or abnormal conditions of the human eye and its appendages;
(9) Order laboratory tests rational to the examination, diagnosis, and treatment of a disease or condition of the human eye and its appendages;
(10) Use a diagnostic laser; and
(11) A licensee is also permitted to perform those procedures authorized by the board prior to January 1, 2010.
(b) An licensee may not:
(1) Perform surgery: Provided, That a licensee may perform a procedure approved pursuant to section ten of this article if the licensee meets the requirements therein;
(2) Use a therapeutic laser: Provided, That a licensee, who has the proper training as determined by the board, may perform the following procedures using therapeutic lasers when such licensee is working in a collaborative arrangement with a licensed opthamologist to provide care to a patient:
(A) An Argon Laser Trabeculoplasty procedure in the treatment of glaucoma;
(B) A Selective Laser Trabeculoplasty procedure in the treatment of glaucoma;
(C) A Peripheral Iridotomy procedure in the treatment of glaucoma; and
(D) A YAG Capsulotomy procedure following a cataract surgery;
(3) Use Schedule I and Schedule II controlled substances;
(4) Treat systemic disease; or
(5) Present to the public that he or she is a specialist in surgery of the eye.
<b>

§30-8-10. Expanded authority for the use of therapeutic lasers and minor procedures.

</b>(a) A licensee may not use a therapeutic laser or perform any minor procedure, other than those therapeutic lasers and minor procedures specifically identified in this article, unless the provisions of this section, along with any legislative rule promulgated pursuant to this section, have been met.
(b) The board with the advice of the Board of Medicine may propose rules for legislative approval in accordance with the provisions of article three, [§ § 29A-3-1 et seq.] chapter twenty- nine-a of this code to permit licensees to use other therapeutic lasers and perform other minor procedures. These rules shall state specifically what therapeutic laser is being approved for use by a licensee, or specifically what additional minor procedure(s) a licensee will be permitted to perform, and provide, at a minimum, for the following:
(1) Provide a list of approved and required courses in the use of the therapeutic laser or performance of the minor procedure(s);
(2) Definitive treatment guidelines which shall include, but not be limited to, appropriate observation for an adverse reaction of an individual following the use of the therapeutic laser or performance of the minor procedure(s);
(3) Continuing education requirements for these areas of practice;
(4) Reporting requirements for licensees using the therapeutic laser or performing the minor procedure(s) to report to the appropriate entities;
(5) That a licensee may not delegate the authority to use the therapeutic laser or perform the minor procedure(s) to any other person;
(6) In the case of a therapeutic laser, a licensee may only use a therapeutic laser when the licensee is working in a collaborative arrangement with a licensed opthamologist to provide care to a patient ; and
(7) Any other provisions necessary to implement the provisions of this section.

[bigeyejim]

Also recall when MDs fought the onslaught of the DOs. Now who knows the difference?

[YrahG]

There really is no need to have these procedures performed by an optometrist.

[drk]

A super-strict interpretation of "surgical" is wrong...Patients need access to ODs for foriegn body removal, I & D of cysts, simple stuff. No sense in putting a hardship on a patient or choking secondary-level providers.(Remember that a tattoo artist can poke anyone with a needle!.)

I agree that there is no shortage of access to surgeons for peripheral iridotomies, posterior capsulotomies, ablation, that sort of thing, so the need for more "help" in this area seems spurious.

[DragonLensmanWV]

A super-strict interpretation of "surgical" is wrong...Patients need access to ODs for foriegn body removal, I & D of cysts, simple stuff. No sense in putting a hardship on a patient or choking secondary-level providers.(Remember that a tattoo artist can poke anyone with a needle!.)

I agree that there is no shortage of access to surgeons for peripheral iridotomies, posterior capsulotomies, ablation, that sort of thing, so the need for more "help" in this area seems spurious.

One argument used is that, of 55 counties, ODs have offices in 50 of them, OMDs only 25 or so. So they could not have to drive from their rural area several hours to OMDs. Some parts of WV are very rural, and the OMDs can't make a living there because of poor patient density.

[drk]

Well, there you go. That's a good argument.

[IndianaOD]

I think OD scope of practice should be uniform to the level of Oklahoma. My perfect scenario.

Educated and licensed certified opticians take care of eye wear.
Optometrists cover all primary and secondary eye care including refractions, medical management, and minor surgical procedures.
Ophthalmologists perform all non laser intra-ocular surgery and manage the really rare ocular diseases.

This would require OD scope to increase only a little in most states (lasers, injections, minor external scalpel) and have ophthalmologists quit competing for primary and secondary eye care.

Patients win with licensed opticians. ODs do what they are trained to do and ophthalmologists get more time in the OR.

[shindog1961]

In New Mexico it was important for us to have minor surgical proceedures, since fb removal, epilation, punctal dilation/ irrigation are classified by insurance as surgical proceedures. So if you aren't licensed to perform surgery, you didn't get paid. That was very effective in educating legislators on "surgery". Being a rural state as well access to care was a very important issue, and almost all legislators veiwed this as very important for their constituents.

[obxeyeguy]

I think OD scope of practice should be uniform to the level of Oklahoma. My perfect scenario.

Educated and licensed certified opticians take care of eye wear.
Optometrists cover all primary and secondary eye care including refractions, medical management, and minor surgical procedures.
Ophthalmologists perform all non laser intra-ocular surgery and manage the really rare ocular diseases.

This would require OD scope to increase only a little in most states (lasers, injections, minor external scalpel) and have ophthalmologists quit competing for primary and secondary eye care.

Patients win with licensed opticians. ODs do what they are trained to do and ophthalmologists get more time in the OR.

First off, I have no issue at all with OD's performing the what the Op has posted.

My issue is with the way the above is stated, and the pie split up. It apears that some would like to expand the scope, but not give anything up. OMD's "perform all non laser intra-ocular surgery and manage the really rare ocular diseases.", now that's going to keep them busy. :hammer:How about the licensed opticians? Do the Od's and MD's still get to dispense, or do we still get to work for them and provide the bulk of the profits to their coffers also? If you want the MD's to give up the primary and secondary care, you should in fact be willing to give up dispensing.

I know, it doesn't work this way. Let's see the reaction if the Oklahoma opticians try to refract.

[fjpod]

All good posts.

[IndianaOD]

OMDs can control their residency slots and control their supply. If they don't increase the numbers it would quickly equalize that they could stay plenty busy. Don't forget cataract surgery is the most common surgery in America. OMD subspecialists (retina, glaucoma, neuro, peds, plastics) around here stay PLENTY busy.

[alexjoan]

I am personally going to optometry school because I like spending less time in school (10+ for OMD, vs 8 or 9 for OD), and I like the great work/life balance that OD have. It seems to me that many ODs are unhappy because they do not have much respect from the public or other health professionals. I hope this will change in the future because the scope of practice is constantly expanding, as it just began as glasses/contacts profession but now includes more medical tx (although this is limited by how much insurances will reimburse). It doesn't really bother me if this perception doesn't change in the future, but if it bothers you at all, go to med school.

[IndianaOD]

I am personally going to optometry school because I like spending less time in school (10+ for OMD, vs 8 or 9 for OD), and I like the great work/life balance that OD have. It seems to me that many ODs are unhappy because they do not have much respect from the public or other health professionals. I hope this will change in the future because the scope of practice is constantly expanding, as it just began as glasses/contacts profession but now includes more medical tx (although this is limited by how much insurances will reimburse). It doesn't really bother me if this perception doesn't change in the future, but if it bothers you at all, go to med school.

Alex,

You are in the UK correct? I think optometry is quite different over there.

[Mr. Finney]

I think OD scope of practice should be uniform to the level of Oklahoma. My perfect scenario.

Educated and licensed certified opticians take care of eye wear.
Optometrists cover all primary and secondary eye care including refractions, medical management, and minor surgical procedures.
Ophthalmologists perform all non laser intra-ocular surgery and manage the really rare ocular diseases.

This would require OD scope to increase only a little in most states (lasers, injections, minor external scalpel) and have ophthalmologists quit competing for primary and secondary eye care.

Patients win with licensed opticians. ODs do what they are trained to do and ophthalmologists get more time in the OR.

Educated and licensed certified opticians? In Oklahoma? I'm not sure if you're saying it should be like this, or you think it is like this, but I can tell you, educated and licensed certified opticians are few and far between in Oklahoma. Unless you're talking about high school educated, licensed by the DMV, and certified to be capable of changing nose pads.

First off, I have no issue at all with OD's performing the what the Op has posted.

My issue is with the way the above is stated, and the pie split up. It apears that some would like to expand the scope, but not give anything up. OMD's "perform all non laser intra-ocular surgery and manage the really rare ocular diseases.", now that's going to keep them busy. :hammer:How about the licensed opticians? Do the Od's and MD's still get to dispense, or do we still get to work for them and provide the bulk of the profits to their coffers also? If you want the MD's to give up the primary and secondary care, you should in fact be willing to give up dispensing.

I know, it doesn't work this way. Let's see the reaction if the Oklahoma opticians try to refract.

We don't need to. That's why MDs and DOs have (un)certified ophthalmic techs!

I am personally going to optometry school because I like spending less time in school (10+ for OMD, vs 8 or 9 for OD), and I like the great work/life balance that OD have. It seems to me that many ODs are unhappy because they do not have much respect from the public or other health professionals. I hope this will change in the future because the scope of practice is constantly expanding, as it just began as glasses/contacts profession but now includes more medical tx (although this is limited by how much insurances will reimburse). It doesn't really bother me if this perception doesn't change in the future, but if it bothers you at all, go to med school.

Unfortunately, it seems like a lot of people liken ODs to chiropractors when it comes to respect, neither of which deserve the poor image the public has of them, in most cases.

[thiaeyemd]

I am a newly trained ophthalmologist who has been in practice for two years. I have tried to keep an fresh outlook on ODs and this whole concept of surgery. These are my concerns. In the two short years that I have been in practice I have had multiple (between 20 and 30) patients who have come to me who have been grossly mismanaged by ODs. It has varied from patients with herpes zoster being treated with steroid drops and made it a lot worse to patients with thyroid eye disease being given antibiotics for 6 months. Now..I can rationally think that there are tons of these patients who are probably being managed great by ODs and not having a problem. The problem is that the ophthalmologists are seeing all the gross mismanagement patients that ODs have treated and seeing a very skewed view. Are there patients mismanaged by ophthalmologists? Of course..but have seen one in two years. The frequency and number make my impression not very good to be honest. When I have a talk with ODs on the phone some of them are quite good but some of them have no more clue than a 1st year medical student. That needs to be sorted out before ODs get more priveleges etc... Remember if a patient has a major problem after being managed by an OD they usually go see an ophthalmologist not another OD. If you were in my position what would be your opinion? I read about surgical expansion and of course I think it is ridiculous. I don't even think a general ophthalmologist should do lasik only corneal specialists and now ODs want to do it? Its just isn't fair to patients until the OD system standardizes people in a better fashion.

[thiaeyemd]

I and D of cysts?? I have had four patients with basal cell and sebaceous cell carcinoma of the eyelids given eyedrops by ODs for months to treat the "infection". The sebaceous cell carcinoma patient ended up failing radiation and dying. Its a damn shame. How would it feel to be that patient's daughter or son? People want to do stuff and don't think of the consequences..only the money.

[wmcdonald]

Dr. Thia,
With all due respect, I hear you loud and clear, but I can tell you , I heve seen some pretty poor management coming from some MDs I know as well. To cover all ODs with the same blanket is not really fair. It is indeed a shame, and should be a crime (at least some form of civil action) to have caused the death of a patient, but today's OD is far beyond the OD of old. I hope you have the good fortune to work with some of the very fine ODs I know personally, and see that they are not all bad. Now.......if I could just get the ODs to see that all Opticians are not stupid, but I guess that is a dream. I do realize that some here are sympathetic to the Optician's plight, but overall, ODs have 0 respect from us at all, except for rare cases.

I am sure some of the ODs here will find my defense of them a bit out of character, but I do try to be objective and feel they have come a long way. I wish my Optician colleagues would follow suit.

[drk]

Doctor, surely sebaceous and sudoriferous cysts are benign entities. Of course followup would be required for all good reasons including catching misdiagnosis. I'm not even talking about a blade on a papilloma or verrucae, I'm talking about a needle.

Having said that, I'm not in the camp that thinks we need more surgeons doing peripheral iridotomies or trabeculoplasty. I do think that we, however, can include just a little bit more for the good of the patient population having easier access to very minor procedures.

And you're right about optometry; it is less homogenous than medicine, and it will be getting worse, I'm afraid. We need higher standards.

[fjpod]

I am a newly trained ophthalmologist who has been in practice for two years. I have tried to keep an fresh outlook on ODs and this whole concept of surgery. These are my concerns. In the two short years that I have been in practice I have had multiple (between 20 and 30) patients who have come to me who have been grossly mismanaged by ODs. It has varied from patients with herpes zoster being treated with steroid drops and made it a lot worse to patients with thyroid eye disease being given antibiotics for 6 months. Now..I can rationally think that there are tons of these patients who are probably being managed adequately by ODs and not having a problem. The problem is that the ophthalmologists are seeing all the gross mismanagement patients that ODs have treated and seeing a very skewed view. Are there patients mismanaged by ophthalmologists? Of course..but have seen one in two years. The frequency and number make my impression not very good to be honest. When I have a talk with ODs on the phone some of them are quite good but some of them have no more clue than a 1st year medical student. That needs to be sorted out before ODs get more priveleges etc... Remember if a patient has a major problem after being managed by an OD they usually go see an ophthalmologist not another OD. If you were in my position what would be your opinion? I read about surgical expansion and of course I think it is ridiculous. I don't even think a general ophthalmologist should do lasik only corneal specialists and now ODs want to do it? Its just isn't fair to patients until the OD system standardizes people in a better fashion.

You should see the mismanaged ocular cases we see from pediatricians, internists, allergists, and physicians assistants. Whew, together we could write a book.

[thiaeyemd]

There are some excellent ODs and there are some poor M.Ds. I agree. All I am saying is that to me...there seems to be a lot more variability in the ODs. Just based on my two year experience. If you were in my shoes what would you think?

[thiaeyemd]

Hi Drk,

I agree but I think that eyelid lesions should be managed by oculoplastic surgeons. Even general ophthalmologists make big mistakes. There are very few lesions where an oculoplastic surgeon treats by popping with a needle. I don't think anyone should be popping cysts on the eyelid with needles. It increases the scarring and has a very high recurrence rate.

P.S Just as a side note..sebaceous cysts are a misnomer. There are no sebaceous glands on the eyelid..They are actually epithelial inclusion cysts. Another lesion if popped tends to just recur.

I send my eyelid lesions to oculoplastic people.Just my thoughts...

[wmcdonald]

I understand your concern, but the OD community has improved 1000 times over the past two decades. The symbiotic relationship that has developed between ODs and MDs provies one of two things:
1. That the MDs working with them in co-management are comfortable with them, or
2. They co-manage with the ODs for the bucks.
Take some time, and get to know these folks. Believe me, no one on the planet felt harder towards them than I at one time, but I got to know them, and realized the new group of ODs really are well trained, and I might add, trained by many of the same people that train MDs in their reesidencies. My only gripe about ODs today is their hypocritical approach towards allowing Opticians to expand their opportunities a bit. You will find that much of the interprofessional rivalry boils down to finances and I am not sure we can solve that in the currnet US healthcare system.

Dr. Thia, welcome to Optiboard. Continue to dialogue with us, and help us a gain more insight into your views. It can only help us all.

[Barry Santini]

IPeople want to do stuff and don't think of the consequences..only the money.

Ditto.

B

[Oedema]

There are some excellent ODs and there are some poor M.Ds. I agree. All I am saying is that to me...there seems to be a lot more variability in the ODs. Just based on my two year experience. If you were in my shoes what would you think?

If I were in your shoes I would feel the same. I've worked with enough disaster OD's and MD's to know that they're out there in both camps, but when those OD's are sending you ridiculous referrals all the time... :hammer:

Makes me wonder why some of these people haven't yet been sued into oblivion.

[Chris Ryser]

1. That the MDs working with them in co-management are comfortable with them, or
2. They co-manage with the ODs for the bucks.

It seems to me that the buck is the ultimate and natural goal of a business association between individuals, professions, or corporations.

I just had the expierience of finding out that being under the care of a MD is at a higher cost than my corporation lawyer. One visit and seeing the MD for 15 minutes the at $300.00 cost without materials would have been $ 1,200.00.

In 2008 I started a thread called "Revenge of the greedy Opthalmologist" which pruced a 155 post and lasted about 12 month. That could give some food for thought. It is at : http://www.optiboard.com/forums/show...phthalmologist