Optometric Physicians

[drballen]

Interesting points of view. Why then is it OK for a physician to prescribe the surgery that they perform? In order to eliminate this dilemna perhaps MD's should have someone else prescribe the surgery. Why is it OK for an optician to recommend AR coating and provide it themselves? All I am hearing are the age old arguements between the O's.
Interestingly enough, opticians in my area do refract, so they don't seem to care about prescribing for themselves. Once you all are refracting (and I bet that many of you will one day if not already) you may have a different opinion on filling your own prescriptions.
It is pointless to apply age old arguements to 3 professions that have changed radically over the past 10 years. Opticians are doing more of what OD's used to do, OD's are doing more of what OMD's used to do, and OMD's look more like corporations than professionals these days, bringing us all full circle.
Keep your stick on the ice, no matter what comes after your O.

Brent Allen OD

[paw]

This is straying off topic, but this is related to the idea of the O's expanding scope of practice:

Given that opticians want the license to (independently) refract, the question is begging to be asked:

If it is unethical to sell what you prescribe, does that mean a refracting optician can't ethically fill his own Rx?

Then what would be the point of opticians getting a license to refract? Chip, care to answer that? :)

[dfisher]

I don't think I'll have to worry about the license to refract in my lifetime. As opticians we can't even get licensed as opticians in a majority of the states. How could we ever get a refractionist license under these conditions.

[Homer]

drballen said:
Keep your stick on the ice, no matter what comes after your O.

:) ;) :D

Brent, I'll remember that one!

You make a good point. As an optician I don't want to refract, in the present climate. I just want to deliver really good eyewear to my friends.

What optician's want more then anything here in the US is national licensure as opticians, not refractionists.

I also find it quite interesting the our Federal Trade Commission has separated the eye examination and it prescription from the provision of eyewear, making them two distinct businesses. They have not done so with surgery or removing foreign bodies.

What I would really like to see is the deregulation of ophthalmic lenses. Make them an "over the counter item" that a person licensed to refract can prescribe like all doctors do for OTC drugs.

[paw]

dfisher said, "I don't think I'll have to worry about the license to refract in my lifetime. As opticians we can't even get licensed as opticians in a majority of the states. How could we ever get a refractionist license under these conditions."

Maybe so, but I am trying to figure out what the deal is here. On the one hand, we have Homer, who keeps putting down ODs at every opportunity, and I believe I read on the Board somewhere that part of his problem with ODs is that they have tried to keep opticians from refracting.

On the other hand, we have Chip, who has vehemently posted (and many on this board have agreed with him) about how it is unethical to sell what you prescribe.

So putting the 2 complaints together, I want to know: can an independently refracting optician ethically sell what he prescribes?

You can see what I'm getting at. If it's ethical, then what's the problem with ODs. If it's not, then what's the point of opticians independently refracting.

[Homer]

If I have a beef with Optometry, it is that they have been the most active force against the official recognition and licensure of opticians in the majority of states.

The other problem I have had with Optometry is their often mis-treatment of qualified, educated professional opticians when they have them on staff; they want to treat them as clerical staff rather than allied professionals --- and pay that way too. (NOT ALL fall into this camp)

Thirdly, the deceptive practice of OD's presenting themselves as physicians, and in our state it was also common to advertise laser vision correction without the modifier of consultation or co-management.

The one thing I am not upset about is OD's not wanting opticians to refract ! (inspite the fact that many of us have been trained to do so and have non-traditional opprotunities to do so)

Yes, If an optician were to gain the right to refract, we might have to address the ethics of the situation you have well described.

[Laurie]

DrBallen: Do you really think that MD's prescribe surgeries as if it were a retail market?

PAW: Not once in my post(s) did I say that opticians should refract autonomously...

Just as you accuse me of using an "age old argument", you are using a "what if" scenario of our (perceived) intentions.

Are you doctors, or retailers...

I just want to know.

: )

Laurie

[paw]

Laurie,
I didn't have your posts in mind when I posted my question about opticians refracting and the ethics of dispensing. I was using this thread to ask a question of Homer and Chip about their related beefs with optometry. Homer answered my question to my satisfaction.

[shanbaum]

Homer said:
If I have a beef with Optometry, it is that they have been the most active force against the official recognition and licensure of opticians in the majority of states.

Is that really true? I always thought that the larger retailers were the chief obstructionists; I don't really see where opposing opicianry (as currently constituted) is in optometry's interest - expansion of the scope of opticianry, sure, but how does licensure of opticians affect optometry adversely?

I was amused by drballens' comment about surgery, but I think it's really true to some extent; go to a surgeon, and the solution to your problem is likely to be, surgery.

Visit an optician, the solution to your problem is a pair of glasses.

Visit an optometrist, the solution to your problem is an eye exam and a pair of glasses.

Visit an ophthalmologist, the solution to your problem is an eye exam, LASIK, and (oops) a pair of glasses.

And if you consult me (an optician turned software developer), the solution to your problem is usually, an upgrade!

[Joann Raytar]

Laurie said:
DrBallen: Do you really think that MD's prescribe surgeries as if it were a retail market?

Laurie,
I am not DrBallen, but everytime I pass a billboard on the highway advertising Lasik at the local laser center or MD's office, I think they are definitely marketing Lasik as a retail procedure.

[Laurie]

Hi Jo,

I agree with you...LASIK advertisements have become very tacky...

I was referring to major surgeries when I posed the question to DrBallen. I don't consider LASIK a major surgery, but a cosmetic procedure (OK everyone, you can start throwing tomatoes now!)

: )

PAW: I thought you were addressing opticians/refracting comments to ALL opticians...I withdraw my statement to you.

And, I would like to thank you and the other OD's on this thread for your thoughtful (AND POLITE) conversation...unlike other OD's here in the past...!

And, (my dear) Robert: I wish it were just the large corps who lobby against us. I can tell you about several cases around the country where the OD lobby blocked licensing attempts, even sued an opticianry school for teaching CL because they were not licensed to fit them in that state! (the hypocracy is almost laughable).

: )

Laurie

[Homer]

You sort of smoothed out all of the arguments with you comments - a wee bit of a reality check.

On the licensing issuse, it is my incomplete understanding that the national eyewear retailers are mostly opposed to the inconsistant standard between licensed states which keeps them from organizing their employees to their best advantage, or the employee's best advantage. They operate in licensed states too so the license, nor the pay, nor education is the real issue. I think a national licensing procedure or at leas state uniformity would be acceptable to them.

On the other hand, it has been my experience that OD's are generally fearfully of knowledgable, educated professional opticians. They know they are not generally equiped anymore to do the work of opticianry. Independent OD's also see Opticians as a direct threat to their eyewear market share.

I agree with you, Shanbaum, that it would be in their interest to see opticianry licensed. In an Optometric Management Forum in Las Vegas, VEW 2000, I stated that "Optometry should force all opticianry to be licensed and therefore be able to control both the chains and independent opticians on their own terms." This statement went way over their heads!

[drballen]

Laurie,
I think that you are missing the point. I write a prescription and fill it. The surgeon recomends surgery and performs it. What exactly are you suggesting is the difference? That patients really don't need glasses , but always do need major surgery? Are you suggesting that a surgeons motives are altruistic? THINK AGAIN. They did not go through a 12 year program in order to do surgery for free. They do it for profit, and that's a lot more profit than either you or I make.
BTW, anyone know the origins of the Canadian saying to " Keep your stick on the ice" and who made it famous? Keep well all.

Brent Allen OD

[Laurie]

Hi DrBallen,

I don't believe that I am missing the point all...I think that we just have different views on the subject.

Many times opticians are referred to as pharmacists of the eyes...

It is in that light that I believe that it is a conflict of interest for you to sell that which you prescribe in the same way that it would be a conflict of interest for an MD to own a pharmacy.

I am not alone in this way of thinking...

Why is it illegal for MD's to own the pharmacy (ie, sell that which they prescribe)?

: )

Laurie

PS: I'm guessing a hockey player, but it is a good saying.

[shanbaum]

I'm with Laurie. It's obviously not desirable for the diagnostician to have a financial interest in the specifics of the diagnosis, be he a surgeon, optometrist, or for that matter, a plumber. Ways of avoiding that conflict of interest are easier to envision in the fomer two cases than in the last - that is, it's pretty easy to see that we could decide that prescribers can't have financial interests in their prescriprions; I can't imagine the world of plumbers being split into diagnostic and remedial specialists. But it would be better if it could be done.

Of course, any given plumbing event might cost more, just as eye exams would certainly cost more, if the refractionists couldn't profit from eyewear. The whole exercise would only be pointful if the overall cost (all eye exams and all glasses) were about the same or lower, or if the quality of service were clearly improved.

There is a difference between the character of a doctor's prescription and an optician's recommendation; an optician can describe the benefits of A/R, but he's not in a position to simply state "this is what you need - take it or leave it", which is one way of looking at an Rx - it's non-negotiable. That's really the key point; after all, it's true that the optician makes more on the $400 lens than he does on the $100 lens - but he doesn't get to write the Rx for the $400 lens, as the O.D. can. It's up to his salesmanship (if you're a cynic) or professional ability (if you're an idealist) to close the more profitable sale.

[drballen]

Laurie,
My point is the analogy between a prescription and and surgery. What exactly is the difference between the two?

Shaun?,
I wish I lived in that world where an OD simply wrote out a prescription for $400 lenses and filled it. In my experience, opticians are much better at suggesting add-ons than OD's, simply because OD's are always trying to avoid the appearance of conflict of interest. That is one great arguement for OD's to have an optician in their office. Consumers are so educated today I don't think that what I recommend holds much stock anymore. Patients will make their own decisions and can usually make pretty good ones.

Stick on the Ice,
This phrase is something that is drilled in to every hockey player from the age of 5, and is still reminded to pros in the NHL every day. You can't score a goal without having your stick on the ice. It was made famous though by the great Canadian comedian Red-Green as the sign-off for his show.

Thanks all for the interesting discussion, nice to here some honost opinions from opticians.

Brent Allen OD

[Joann Raytar]

Laurie said:
I can tell you about several cases around the country where the OD lobby blocked licensing attempts, even sued an opticianry school for teaching CL because they were not licensed to fit them in that state! (the hypocracy is almost laughable).

That is sad to read. I have said before, as in the case of opticians refracting, that even though a group doesn't actually practice a service they should know as much about it as possible. Teaching CL, or refracting, has a higher value in terms of a fully educated professional who understands every aspect of their patient/customer's eyecare experience.

Perhaps Homer is correct when he writes about how other professionals view educated Opticians. This makes the situation even sadder when you think of how important education will become for future Opticians. If the way to make sure Opticianry survives is formal education, it is sad to think that they will inherit their own good fights. It seems that there is always an obstacle when a group is trying to bring itself up a step.

[p944t]

Let me clear up something the AMA is a trade organization, just like the AOA. As such no one should be regulated by either. The AMA does NOT regualte MD's. The medical boards also has an agenda. Ask any dentist, poiatrist, psychologist, pharmacist, ect. They each want to and should be regulated by their own board.

Each of the above professions have had to fight to survive. If organized medicine had its way there would be no optometrists. Remember MD's tried to get rid of DO's (allopathic physcians- which have the same basic traing as MDs. That includes DO ophthalmologists and every other specialty. In addition, I feel that Opticians should also have its own board - not being under the medical or optometry board.

Relating to another thread why the refraction has to be billed out seperately under medicare: This is how the medical boards where able to stop ODs from billing medicare. Until recently, medicare would reject all claims sent in by ODs. The reason was purely money. The three O's continue to cause each other harm. Hopefully websites like this can improve relations. Are there any MDs joining this site? I hope so.

[paw]

I think it benefits the patient if they get the exam and the glasses from the same office, because:

1. Often the patient has eye health issues that affect their vision, that glasses can't "fix", and the independent dispenser wouldn't have a clue.

I can give my own mother as an example. She has corneal dystrophy. With the best lenses, options, frame, and fit that we can provide, she still can't see as clearly as she would like, and we in the office know why that is. Can you imagine if she got her exam in our office and then went to your dispensary to get her glasses? She would come back to you and say, "I can't see with these glasses." And your best efforts wouldn't help her and you would write her off as someone who can't be pleased, and she would be upset that her new glasses did her no good.

We in the office occasionally find ourselves reminding our patients, "Remember that the Dr found such and such condition, and new glasses won't make you see clearly."

Before you accuse me of selling glasses to someone who wouldn't benefit, let me say that we always tell people when glasses aren't needed, but sometimes they want new glasses anyway. They want a new frame, or their old lenses are scratched or whatever.

2. Even when there are no eye health issues, you have people with adaptation problems. I can just see the fingers of blame being pointed at each other. "The OD didn't give you an accurate Rx" vs "The otpician didn't fit you properly."

[Joann Raytar]

paw said:
I think it benefits the patient if they get the exam and the glasses from the same office, because:

1. Often the patient has eye health issues that affect their vision, that glasses can't "fix", and the independent dispenser wouldn't have a clue.

I can give my own mother as an example. She has corneal dystrophy. With the best lenses, options, frame, and fit that we can provide, she still can't see as clearly as she would like, and we in the office know why that is. Can you imagine if she got her exam in our office and then went to your dispensary to get her glasses? She would come back to you and say, "I can't see with these glasses." And your best efforts wouldn't help her and you would write her off as someone who can't be pleased, and she would be upset that her new glasses did her no good.

2. Even when there are no eye health issues, you have people with adaptation problems. I can just see the fingers of blame being pointed at each other. "The OD didn't give you an accurate Rx" vs "The otpician didn't fit you properly."

While I agree the situation in Point 2 can easily arise, I disagree with Point 1. Point 1 is the reason I wish prescribing Doctors would include VA's on Rx's. However, I (and I believe most others) would not just write a patient off. After verifying everything I had on hand, I would call the prescribing doctor and ask if there are any pre-existing health issues and ask what the best corrected VA's are. Almost any Optician would do this. No offense to any of the doctors, OD's and MD's alike; however, a qualified Optician is the best individual to neutralize new eyewear and compare them to a patients previous eyewear and the written Rx. It is rare to meet a Doc who is as adept around a lensometer, a lens clock and a PD stick as a well trained Optician. Laugh at those three items but they will tell you a great deal about a pair of glasses.

[Homer]

That last response was great! Couldn't have said it better myself.

At 27 I was "managing" (mostly myself) an independent, mainstreet optical office that saw mostly Rx's from MD's. It was apparent, even then with only 7 years under my belt in the industry, that the Doctor did not fully inform the patients of the nature of their problems and their options. I counceled many a patient who was facing the old 3-day-hospital-stay cataract surgery in what to expect and why they were having trouble with their new glasses.

Basic VA's and abnormal vision situations noted on the Rx would be super, however most OD's think that opticians couldn't understand such complicated stuff and most MD's are either too busy or forget.

As an independent optician who filled the who was not associated with any person calling themselves doctor, about 30% of my Rx's were from independent OD's who had dispensaries but not real optician. Guess what? Some people know the difference!!!

Rare is the OD who is a good dispenser of the products he / she prescribes. If you took away the wholesale lab babysitters who often walk OD's through dispensing difficulties you would have a lot of OD's getting out of the eyewear dispensing business.
I have never seen an OD Rx that prescribed a slab-off. Of course the MD Rx rarely states it either but at least they expect opticians to know when one is appropriate.

Fortunately, some OD has Jo to make him / her look really good.

[docwatson]

Jo said:
It is rare to meet a Doc who is as adept around a lensometer, a lens clock and a PD stick as a well trained Optician. Laugh at those three items but they will tell you a great deal about a pair of glasses.

I agree with this statement. There are many doctors out there who do not have the slightest clue what they are doing in the optical. However, I want to pat myself on the back. These are things I check for when a patient has symptoms of a poor fit. :D

On another note...

I don't see how it is a conflict of interest to prescribe and sell glasses too. Are some of you trying to make the point that unethical behavior might arise from such a situation? If you think about it, unethical behavior will arise from ANY SITUATION and there's nothing that can be done about it!

There can be laws that limit such behavior but the fact is, everyone is trying to make a living, so unfortunately, we all ride a fine line. I bet no one here can name a profession where selling is not the rule. Everything costs money so everything should be under scrutiny for unethical behavior right? Some people claim that yearly eye exams are not necessary, others do. Some people claim that glasses add-ons are not necessary nor should be suggested, others do. Where do you draw the line?

I'm a firm believer in ethics, but like I say, it's all a matter of where you draw the line.

[Homer]

DocWatson said: If you think about it, unethical behavior will arise from ANY SITUATION and there's nothing that can be done about it!

And I think that it is kinda funny that optometry statutes in every state are getting longer and longer and they are mostly speaking to the ethical practice of licensees - not us "unlicensed persons".

Hmmmm?


These laws speak to and control how optometrist act, not about how others act or do business. So, guess where the problem is.

This is why they have to be reminded not to present themselves as physicians - because that is not in the best interest of health and welfare of the public - or to state in their ads "laser vision correction"

[paw]

Homer said:

Rare is the OD who is a good dispenser of the products he / she prescribes. If you took away the wholesale lab babysitters who often walk OD's through dispensing difficulties you would have a lot of OD's getting out of the eyewear dispensing business.
I have never seen an OD Rx that prescribed a slab-off.

Oh come on, Homer. How would any private practice OD stay in business if they were as bad as you think. Our practice grows because the doctor provides excellent eye health care and the dispensary provides excellent service. BTW, our Dr has prescribed slaboff.

[Joann Raytar]

paw said:
...and the dispensary provides excellent service.

I could be wrong, it wouldn't be the first time, but I believe that is the point Homer was trying to make. The fitting, fabricating and dispensing of eyewear, even in a professional office, is only as good as the individuals in the dispensary and the in-house lab, if there is one. It sounds like your office has put some thought into all aspects of your business; not every office does.