Breaking News in the Great Glasses Court Case

[Excalibur]

My understanding is that in Ontario, an OD cannot hire a licensed optician. If someone can cite evidence to the contrary in legislation, please post to the list.

Having said that, what is the salary range for an optician in Ontario?

[Dave Nelson]

I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)

[Ory]

There is nothing prohibiting an OD from hiring an RO. I know of a few practices that do so.

Correcting yours:

(4) It is a conflict of interest for a member to,

(e) engage in the practice of optometry in association, partnership or otherwise with or while employing or under the employment of a vendor of ophthalmic appliances or an ophthalmic dispenser registered under the Ophthalmic Dispensers Act or with any other person or corporation other than,
(i) with a member who is engaged in the practice of optometry,
(ii) with a legally qualified medical practitioner who is engaged in the practice of medicine provided that such practice is not inconsistent with Part V of the Act or regulations or by-laws,
(iii) as an employee or agent of a municipal or other government, agency of a municipal or other government, a university, hospital,
(iv) with a community health centre if the employment or any arrangement has been approved by Council, or
(v) with a corporation for the sole purpose of providing optometrical counsel and service to the employees of the corporation; or
(f) own or financially benefit from the operation of a company, firm or business that manufactures, fabricates, supplies or dispenses ophthalmic appliances. R.R.O. 1990, Reg. 550, s. 26 (4).

In other words, an optometrist may not work with or for an optician.

[Dave Nelson]

Good heavens Gregory, it's 11:30 in Ontario. Shouldn't you be getting to bed?

[Ory]

Worst part is I have a 1-day LASIK follow up tomorrow morning. Also my wife's due date. Will likely be a busy weekend!:cheers:

[Dave Nelson]

Keep us posted on that big day. (I mean the baby, not the lasik check.):cheers:

[HarryChiling]

I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

Now you can crucify me.

[Excalibur]

Thanks for the post. That clarifies the issue.

Correcting yours:



In other words, an optometrist may not work with or for an optician.

[Excalibur]

Dave,

One of my best assistants is Rocco. He's been working in my office for 8 years, and I'm pretty certain he doesn't wear a pink thong. He's got a couple of blue tatoos. In fact, he'd probably give you a black eye because when he reads your comment he'll sure being seeing red.

If the law allowed me to hire an optician, I probably would. To date, I've done very well hiring trainable staff who work with me and the patient. We dispense over 80% of the patients who are in the office and require eyewear changes. No 'arm-twisting' tactics required-- just competent service, reasonable fees, great reputation in the community and a lot of referrals from satisfied patients. I don't think my patients have been harmed by having unlicensed staff. My staff and I rarely make lens rx/dispensing errors including 'upside down' PAL rxs.

We are also busy because our patients, family docs, several endocrinologists and OMDs send us new patients. They advertise our practice for us. Are we greedy? Sure! and... we take our jobs seriously but we don't take ourselves seriously.:bbg:


-----------

I know of no law in Ontario that prohibits optometrists from employing opticians, but I can speak about B.C. B.C. optometrists are "allowed" to employ opticians, but are not permitted to be employed by opticians. I am unclear about the act which sought to prohibit optometrists from even working where an optician was employed, since it was challenged in court, and the optometric regulatory board lost. The judge ruled that although the optometrists did "yeoman's service" in trying to convince him of the conflict of interest that would result if the two groups were permitted freedom of association, he ruled that, since optometrists already sold the devices they precribed, the potential for conflict was just as great, and perhaps even greater.
Optometric efforts to save costs by paying less for "assistants" or other ancilliary personnel is a free market decision: go ahead, excaliber, you get what you pay for, and your patients will too . When you do get well qualified people who you trust who can do the more difficult work of a well qualified optician, consistantly sell good quality eyeglasses with few patients returning to complain or badmouth you and your office all over town, you can either pony up the bucks to pay a fair salary, or watch your best staff leave for greener pastures, while you hire the next trainee who edges 1.67 ellipse lenses upside down, chews gum, and thinks her pink thong looks hot crawling up her backside for all the world to see. Good luck with that. ;)

[Excalibur]

Most ODs don't disagree with trained technicians doing refractions within the confines of an ophthalmic practice where at least the refraction has been performed as part of an overall ocular assessment. I believe all ODs (and a lot of MDs.. and drum roll please... opticians too) do not agree with opticians stand-alone refractions.

You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations. That's greed? Really.
Your comment that optometry is a greedy is not only nonsense, but just plain asinine.

------------

I just erased the longest post I have ever written, the point is that optometry is a greddy profession. That was the gist of the whole post. In reality, in a medical office; allied health professionals are regularly hired to perform refraction for OMD's and a medical eye exam does not include a refraction as a routine part of the exam. The insurance companies don't consider refractions as medically necessary. The only people who think that refracting is the greatest thing since sliced bread is optometrists. In reality if opticians were allowed to refract their wouldn't be much of a place left for optometrists and I can live with that being the reason for optometry fighting so hard to keep refraction a skill that only they are allowed to perform, but to dress it up as for the good of the patient is nonsense. In that case you would say hey I don't understand as much about glasses as the guy down the road go visit him, or I don't understand as much about pathology as the OMD up the road go see him.

I think that all three O's have things that they are good at and specialize in, Opticians fabricate and dispense glasses this is our specialty, Optometrists refract and fit contact lenses that is their specialty, Opthalmologists diagnose and treat pathology that is their specialty. If it is OK for an optometrist to open up an optical dispensary in their office without really understanding fabrication and the intricaies of dispensing, I don't see why it is not OK for opticians to perform refractions.

The eyelogic systems are used in the US in OMD's offices as well and the OMD signs off on the exam. It is techs that perform these diagnostic tests and the OMD's that interpret the results and sign off on the scripts. These machines make refraction a science again as compared to magic as most optometrists try to make refraction out to be. Hey don't be upset I am sure a few opticians lost their jobs when automated lensmeters came out. They are making edgers now that a layman can figure out. Their is no magic in our field it is science and the offices that I have worked in that have embraced that are by far the busiest and best practices that I have worked for. I currently work for an OD, who is the best optometrists hands down. Everyone in our office has something they are good at and if I asked my doctor now how to refract (don't need to becasue I already know) she would not only show me how, but I am pretty confident she would show me how to do it correctly and show me some tips and pointers so that I would not only know how to refract, but could refract competantly, on the same note if anyone in my office wants to know how I do my job I don't pull out the smoke and mirrors I teach them and teach them to be the best or as good as I am. I have not found that to be the case with optometrists in the past most have tried to obfuscate refraction like it was this overly complicated procedure. The funny thing is that most opticians have been taught not only the science in our industry, but the art. I would have to say hands down I have learned the most rarest and most valuabe information in the short amount of years I have been doing this from opticians, if we can't share our knowledge and profession it's the other O's that will lose out.

Now you can crucify me.

[Jubilee]

Optometrists should not be employed by dispensers for the same reasons physicians should not be located inside pharmacies and employed by pharmacists.

So you don't have the whole "minute clinic" deal springing up all over Canada?

Here in the US many pharmacies have nurse practicioners (who can prescribe meds) located within their businesses to offer routine low level care... such as treating respiratory infections, sore throats, flu, infections..etc..

So much for that separation....

[Ory]

Now you can crucify me.

Harry,

I have a lot of respect for your knowledge. You consistently post reasonable, well thought out comments.

In this case, I take exception to 2 items. The first is labelling all optometrists as greedy. I think most people who know more than one or two of us will find that to be the exception rather than the rule. I could easily say opticians are all lazy and uneducated based on one or two I have met, but I''m well aware that isn't the case. So please stop with these insulting blanket statements.

The second issue I have with your post is stating that without refraction there would be no need for optometrists. You are of course entitled to your opinion, and I'm sure I won't be able to change it. In the area I work in we have a shortage of ophthalmologists. Optometrists refract, assess binocular vision (something no one else does), perform minor procedures (punctal plugs, foreign body & rust ring removal, etc). Once the Ontario government gets its act together we will have the best pharmaceutical privileges in the country. Currently I just request the appropriate meds from the patient's GP, most of whom understand that I know what I'm talking about. So basically, I provide primary care. There is no need to see an ophthalmologist for much short of surgery, of which there is enough demand that everyone is happy.

I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.

[shawn b]

Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.

[HarryChiling]

You consistently post reasonable, well thought out comments.

I really try to stay out of these discussions, but what happens is everytime their is a discussion about the subject it seems that all the optometrists that post have the same canned response. This usually gets me froathing around the lips and all of a sudden I have said some stuff, I probably should not have said. I know that optometrists do have a place in the whole system and will probably always be the bioggest role, but the whole belitlle another profession to make ones own profession just gets old.

You also quote that optometry is a 'greedy' profession. Where I practice (Ontario), many retailers charge $600 for something I can't charge more than $400 because of dispensing fee regulations.

This quote of yours reminds me of an old expression "look at the pot calling the kettle black". You must be upset that you can't charge more. $$$, it's not fair.

I know that when opticians get the right to refract I will be OK. And yes, I used the term "when" because I have no doubt it will happen. I'm not happy about it, I strongly disagree with it, but it is the most likely end result.

Absolutely you will be OK, if you embrace the change what will happen is these opticians will be refering their patients to you for various reasons, opticians can be your greatest ambassadors. I think that the change creates fear and this is what leads to the unrational thoughts, both on my part and on some of the optometrists that post whenever this subject comes up. I always make it a point to make my opinion be know on this subject, because it will only make my position stronger the more I debate on it. I have consistently seen optometrists argue their point about this subject untill they are blue in the face and their position only gets stronger, if I can empassion one optician to try and make change the tides will turn. No offense meant to anyone, but if you lay in front of a tank you get run over. ;)

[Excalibur]

Of the 3 "O's", optometry has had the greatest success from a legislative perspective across North America. Optometry is a 'centrist' profession, meaning it provides the widest breadth of diagnostics and treatment modalities for the vast array of ocular anomalies. This has created some marginalization of opticianry and ophthalmology. It is, however, important to recognize that each of the professions does have it's strengths.

If adults believe that the best interests lie in providing free-standing 'refractionaries', then perhaps this should be made a part of the federal government's election platform. And yes, "patients don't know what they don't know" ... I see this all the time in my practice when I (and my colleagues) diagnose asymptomatic eye disease. As you know, the eye does not have a sophisticated 'early warning system'.... and regular ophthalmic consults/assessments help in reducing the risk of eye disease despite what a refractionist might say.

---------

Excalibur... I can understand your position, but I find your arguments quite weak. You are correct to say that comprehensive eye examinations should be available, but only as an option... not as a requisite.

My comment was that as adults living in a democratic society, should we not have the right to choose what type of treatment we want? Your rebuttle, brings forward the idea of obtaining prescription medication from a vending machine, and the necessity of PAP smears. I cannot make the connection, but what I dislike is the arrogrant attitude brought forward in your comment that the "patient" "doesn't know what they don't know". What does that mean? That you get to decide for everyone else? That your knowledge is so vast and deep that you know the correct thing for me and my health? No thank you Excalibur. I don't need anyone making decisions for me or my health. People should be educated and information should be available for them to make their own decisions.