OD vs OMD

[thiaeyemd]

I practice in New York City and I don't know any ophthalmologist who gets paid 1200 for 15 minute office visit. It is more in the 100 to 130 dollar rate...Check out the medicare reimbursement rate for a new patient visit. That is sort of standard. Not sure where you got your information.

[MarySue]

I think every profession should be allowed to better themselves and give more to their patients.

[chip anderson]

The answer to this question is simple. O.D.'s as a group are much better at refraction (at least those who function as O.D.'s and do primarily refraction), they tend to be a whole lot better at refraction than techs also. MD's as a group are much better physicians and surgeons. Some MD's are great refractionist but many do so little of it if any they are not the top of the refractionist. OD's who chose to practice medicine as a group are very poor at it. You will notice that most of thier publications are more centered on how to get paid for a certian proceedure or drug, or Rx or diagnosis, or even the use of the new super gadget for the office. Little attention is given to the need or benefit to the patient from same.

Chip

[drk]

Thanks for the kind words about our "refracting" Chip.

Question for you: Do you feel primary care physicians do an overall better job with anterior segment eye issues? Do you think specialists are better suited for this level of care?

What do you think, in a public health way, about access to ophthalmology for, say, dry eye or red eyes? Do you think specialists are best suited for this level of care, or subspecialists such as cornea?

[eye2]

Mr MD. You haven't been around long enough to make that judgement. I have been in the optical business for over 30 years in that time most of the OD's I seen are very good. Now there were a few I wouldn't let my dog see but not many. MD's ( and I have worked for quite a few ) have one thing in common, DOLLARS are very high in there sight. There was one MD in town that if you went for cataract surgery you were guaranteed a cylinder of anywhere from 1.50 to as high as 4.00. Maybe a little dicey with the knife I'm not sure. But everyone had cyl. Another MD had penchant for treating everybody with what the people described to me as a syringe full of oil after there cataract surgery. Another MD would tell us what we could and could not give to the patient in the form of glasses. He had passion for being resistant to photo gray lenses. I had a patient that wanted them, I called doc where as he said let me talk to patient all I could hear was screaming from the phone as the doc let him know he would not ok. Would you like me to go on? I Have mor
e stories, but just say like you said there are some bad and good in every group.

[chip anderson]

As to dry eyes, basicly I think this is one of the more over diagnosed, more over treated conditions there is. With the exception of some menopausal females and others with rhumatoid. I think it's a condition that if treated at all with a drop of castor oil, no O.D., No OMD, or anything else required. It's really amazing how much more this is diagnosed now that $10.00 puntum plugs can be inserted in 10 min. for $450.00. And how popular restasis is now that it advertises as much as it does.
It's kind of like when they advertised Clearatin for three months before anyone knew what it was for. People were calling thier doctors asking if they could take Clearitin (I'm sure the doctors loved being bothered by someone who didn't even know if they had a condition it would help.)
If by "red eye" you mean conjunctivitus (formally known by a lower priced name as Pink Eye) most of the time any GP could handle it. Probably so could the pharmacist.
And yes, I do recognise that the OMD's are now getting so proud of their time that one cannot get to see them in less than four weeks.

Chip

[OHPNTZ]

As to dry eyes, basicly I think this is one of the more over diagnosed, more over treated conditions there is. With the exception of some menopausal females and others with rhumatoid. I think it's a condition that if treated at all with a drop of castor oil, no O.D., No OMD, or anything else required. It's really amazing how much more this is diagnosed now that $10.00 puntum plugs can be inserted in 10 min. for $450.00. And how popular restasis is now that it advertises as much as it does.
It's kind of like when they advertised Clearatin for three months before anyone knew what it was for. People were calling thier doctors asking if they could take Clearitin (I'm sure the doctors loved being bothered by someone who didn't even know if they had a condition it would help.)
If by "red eye" you mean conjunctivitus (formally known by a lower priced name as Pink Eye) most of the time any GP could handle it. Probably so could the pharmacist.
And yes, I do recognise that the OMD's are now getting so proud of their time that one cannot get to see them in less than four weeks.

Chip

Where can you order $10 punctal plugs? And where can I get that reimbursement?

And what is clearatin?


You forgot to mention sjogren's, a whole list of medications with side effects....quite possible clearatin...


Having been a dry eye sufferer since college, ans not knowing what it was till optometry school, and not being diagnosed until then...I can really relate to any patient suffering from it.

[Oedema]

As to dry eyes, basicly I think this is one of the more over diagnosed, more over treated conditions there is. With the exception of some menopausal females and others with rhumatoid. I think it's a condition that if treated at all with a drop of castor oil, no O.D., No OMD, or anything else required. It's really amazing how much more this is diagnosed now that $10.00 puntum plugs can be inserted in 10 min. for $450.00. And how popular restasis is now that it advertises as much as it does.
It's kind of like when they advertised Clearatin for three months before anyone knew what it was for. People were calling thier doctors asking if they could take Clearitin (I'm sure the doctors loved being bothered by someone who didn't even know if they had a condition it would help.)
If by "red eye" you mean conjunctivitus (formally known by a lower priced name as Pink Eye) most of the time any GP could handle it. Probably so could the pharmacist.
And yes, I do recognise that the OMD's are now getting so proud of their time that one cannot get to see them in less than four weeks.

Chip

I wholeheartedly disagree. Dry eye is one of the most common eye "conditions," but certainly one of the most under diagnosed by both OD and MD. I know that you've had alot of experience as a CL fitter, certainly you've stained a lot of corneas with NaFl and seen how common SPK is? If you can get me some $10 punctal plugs please let me know where, if they were actually that cheap I might actually use them.

If castor oil is really as great as you claim then I'd expect Restasis to work a whole hell of alot better (I don't think much of it either) - the vehicle for Restasis is Refesh Endura (aka castor oil).

[fjpod]

... OD's who chose to practice medicine as a group are very poor at it...

Chip

Welcome back Chip.

Try this on for size...opticians who practice medicine are very poor at it...
Where did you get all this medical knowledge about dry eye?

tick, tick, tick...

[OHPNTZ]

The problem I have with the posts is that some optician may read what Chip posts, believes that what he says is 100% accurate, then doubts the diagnosis of patients where he or she may work.

Systane balance now has mineral oil in it...and I believe I read where castor oil is an ingredient in a drop...

[Oedema]

and I believe I read where castor oil is an ingredient in a drop...

Refresh Endura, which also happens to be the vehicle for Restasis.

[jediron1]

The problem I have with the posts is that some optician may read what Chip posts, believes that what he says is 100% accurate, then doubts the diagnosis of patients where he or she may work.

Systane balance now has mineral oil in it...and I believe I read where castor oil is an ingredient in a drop...

Get a grip OD's. You take Chip with a grain of salt some claratin and say goodnite

[chip anderson]

Fjpod:

If you want to know where I got my knowledge about Castor Oil, it was from Dr. Louis Girard, MD who was the head of Baylor Medicine's department of ophthalmology for 24 years. If you want to know where he picked it up, PM. Me and I'll tell you.
If you noticed the FDA itself came out with a statement itself a while back stating that it had been remiss in granting approval for Restasis as a drug, when it found that most of it's action was due to the vehicle (Castor Oil)
itself. Such was posted by others I think with a direct reprint during my last stint on Optiboards.

Chip

[fjpod]

Fjpod:

If you want to know where I got my knowledge about Castor Oil, it was from Dr. Louis Girard, MD who was the head of Baylor Medicine's department of ophthalmology for 24 years. If you want to know where he picked it up, PM. Me and I'll tell you.
If you noticed the FDA itself came out with a statement itself a while back stating that it had been remiss in granting approval for Restasis as a drug, when it found that most of it's action was due to the vehicle (Castor Oil)
itself. Such was posted by others I think with a direct reprint during my last stint on Optiboards.

Chip

Thanks for the response, but the question about where you got your medical knowledge was asked rhetorically. The real question is why do you chide ODs for "practicing medicine" in one breath and then you do it yourself in the other?

[fjpod]

Get a grip OD's. You take Chip with a grain of salt some claratin and say goodnite

If Chip can dish it out, then he's gonna get some back. I suspect he can take it. goodnight Gracie.

[jediron1]

I practice in New York City and I don't know any ophthalmologist who gets paid 1200 for 15 minute office visit. It is more in the 100 to 130 dollar rate...Check out the medicare reimbursement rate for a new patient visit. That is sort of standard. Not sure where you got your information.

As was mentioned before you've only been in practice for two years you haven't seen everything. I once worked for a MD who charged $175.00 per office visit in 1995. Reason I know this is the gentleman came to me for glasses and showed me the bill. He was upset. So I could find Chris's statement of $300.00 but 1200 would be stretch.

[OHPNTZ]

Get a grip OD's. You take Chip with a grain of salt some claratin and say goodnite

There are those of us who know Chip and his ways, but again, I am concerned about the new members who are not familiar with Chip.


All it takes is one person, who turns to this board for info, who may believe what he says is true...

[eye2]

There are those of us who know Chip and his ways, but again, I am concerned about the new members who are not familiar with Chip.


All it takes is one person, who turns to this board for info, who may believe what he says is true...

If you noted Chip said he got the info from Dr. Girard. And if I remember correctly the said doc was considered the formost educater on contact lenses in his day.

[OHPNTZ]

If you noted Chip said he got the info from Dr. Girard. And if I remember correctly the said doc was considered the formost educater on contact lenses in his day.

The problem lies with the "over-diagnosis" statement about dry eye...and the obscene gross estimation of punctal plugs...

[IndianaOD]

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.

I have seen some pretty bad cases from ophthalmologists so I wouldn't go too far down that bunny trail. From misdiagnosed frank glaucoma to brain tumors.

[IndianaOD]

The answer to this question is simple. O.D.'s as a group are much better at refraction (at least those who function as O.D.'s and do primarily refraction), they tend to be a whole lot better at refraction than techs also. MD's as a group are much better physicians and surgeons. Some MD's are great refractionist but many do so little of it if any they are not the top of the refractionist. OD's who chose to practice medicine as a group are very poor at it. You will notice that most of thier publications are more centered on how to get paid for a certian proceedure or drug, or Rx or diagnosis, or even the use of the new super gadget for the office. Little attention is given to the need or benefit to the patient from same.

Chip

Chip, Check out the malpractice report recently. Can't remember if it the AOA journal or the AAO journal. VERY few malpractice cases considering that over 2/3 of people get eyecare from an OD.

[chip anderson]

Actually I think to prove malpractice one must have some resultant harm. One is not usually harmed by un-needed test, pictures, etc. Or even by placebo effect drops and prescriptions. The OMD would be more liable for same because:
Surgery, ocular injections, etc. are more likely to cause harm or be precieved as harmful. Not to mention they are more likely to have the big bucks to sue for. Not disputing what you say, just it's a little of an apples to oranges comparison.

[jediron1]

The problem lies with the "over-diagnosis" statement about dry eye...and the obscene gross estimation of punctal plugs...

According to Odyssey Medical, national average for initial insertion is 100% at a cost of 128.88 per. After initial insertion any follow up visits are covered at 50% or on national ave. $64.00 per plug. And you know these are usually replaced on a weekly by weekly or monthly basics. So if you use for example monthly that would come initial visit $256.00 next month 128.00 for a year would equal $1664 for both eyes. So chip was not over extended on his price at all. He might have been over extended if he meant for initial visit that was a little high.

[jediron1]

Where can you order $10 punctal plugs? And where can I get that reimbursement?

And what is clearatin?


You forgot to mention sjogren's, a whole list of medications with side effects....quite possible clearatin...

Having been a dry eye sufferer since college, ans not knowing what it was till optometry school, and not being diagnosed until then...I can really relate to any patient suffering from it.

Why didn't you mention rheumatoid arthritis, or what are the patients daily routines? Or how they did on artificial tears and other therapies? What about Schirmer or Liss. Green to test for tear production? I wouldn't Get on Chip for not mentioning a couple things when it's all said and done you both didn't mention everything. And neither did I.

[fjpod]

According to Odyssey Medical, national average for initial insertion is 100% at a cost of 128.88 per. After initial insertion any follow up visits are covered at 50% or on national ave. $64.00 per plug. And you know these are usually replaced on a weekly by weekly or monthly basics. So if you use for example monthly that would come initial visit $256.00 next month 128.00 for a year would equal $1664 for both eyes. So chip was not over extended on his price at all. He might have been over extended if he meant for initial visit that was a little high.

Do you believe everything you read...from a vendor? The fact is, most drs. use synthetic or "permanent" plugs. The synthetic usually last 3 months, and the permanent ones...well I've seen some still in place after 3 years.

Now lets talk about that gravy train called A/R coating...