I recently read a blog from a first-year ophthalmology resident talking about how ODs shouldn’t be performing medical treatments. I’ll leave his utter ignorance of his own lack of knowledge aside for just a second and address the responses by my esteemed colleagues Drs. Ernie Bowling and Mohammad Rafieetary. You two are both extremely knowledgeable and way too nice.
My friends, I have a dream-no, not a dream of little optometrists and little ophthalmologists playing together in harmony. A dream of legislative justice. A dream of redressing decades of wrong. In short, a dream where monopolies are broken and patients aren’t the children caught in the middle of warring parents.
I recently read a blog from a first-year ophthalmology resident talking about how ODs shouldn’t be performing medical treatments. I’ll leave his utter ignorance of his own lack of knowledge aside for just a second and address the responses by my esteemed colleagues Drs. Ernie Bowling and Mohammad Rafieetary.
You two are both extremely knowledgeable and way too nice. I can speak directly to Mo’s (as SCO students affectionately refer to Dr. Rafieetary) body of knowledge, having studied under him as a student at SCO, and the guy is brilliant and would be able to embarrass Dr. Oakey in a matter of seconds.
That said, while I respect you being both professional and kind, as optometry’s “loose cannon,” I don’t feel restricted by the need to be either of those things and would rather simply say some things that need to be said.
In my dream, a scope bill actually makes it to the floor of Congress and is being argued against by the ophthalmology association, and I finally stand up and say the following:
“Seriously? Is nobody actually going to call bullshit here? Well, allow me to be the first. Ladies and gentlemen of the Congress, you’re the victim of a ruse. A coordinated and well-organized and funded ruse, but total crap nonetheless. We listen over and over to the wolf crying (oh, the irony with Dr. Oakey calling us wolves in sheep’s clothing) over how we’re going to kill our patients, but these are the undeniable facts.”
Next: The gloom and doom of OD scope of practice
In the 1970s, the streets were going to run red with the blood of the dilated because ODs wanted to better examine their patients. People were literally going to drop like flies. In the 1980s, we were going to kill them with topical antibiotics and create superbugs-literally kill them.
The ‘90s brought us the impending doom of ODs treating glaucoma and the mass blinding and death of uncountable patients. The 2000s heralded the apocalypse we were going to drop on millions with oral medications.
Here we are in 2015, with ODs still trying to expand our scope to what our education was in the 1980s. In short, the Sword of Damocles has been hanging over the heads of our patients for over 40 years-so that leaves me wondering about one thing: where are all of the deaths and blind people?
You see, ODs treating disease is no longer some conceptual point to wonder where MDs can throw out scary buzzwords and semantics. It’s a tangible reality, and in that light, you would think that some insurance company, litigator, news media-hell, anyone-would have data to actually support those claims.
We hear over and over the danger ODs pose, but the reality is that it simply isn’t true and the objective data (malpractice stats, rates, negative judgements, etc.) say quite the opposite. This is the reality that the American Medical Association (AMA) doesn’t want you to hear.
They want you to be scared. They want you to be manipulated with rhetoric. But the truth is that this is about two things: money and power.
Next: Restricting ODs' scope of practice
OMDs want to hold on to the functional monopoly they’ve held since the beginning with zero consideration for the well-being of the patient. It’s not a money thing for us because we’re already seeing these patients. They’re our patients, and they have conditions well within both our education and board scrutiny that need our treatment.
For example, in Texas, a patient can come to me with a herpetic ulcer and-despite being held to the exact same medicolegal standard as an OMD-I can only half treat them. I can prescribe the necessary topical meds, but I have to call my friend the nurse practitioner to write the oral antiviral they need.
As another really great example, I’m licensed as an optometric glaucoma specialist, but I can neither independently diagnose nor treat that condition.
My patients are required to have an annual visit with an OMD. Now, I do all of the testing, and no matter what they say, I can change it, but the patient still has to take a second day off work as well as pay a second insurance copay for nothing more than a legal formality.
The ugly truth about Texas laws is that when I graduated in 1999, the laws in Tennessee allowed more than our current Texas law-that’s 16 years, in case the math escaped you.
That’s the functional reality of being an OD. We see roughly 85 percent of the primary eyecare encounters in this country, and based on our stats in a ridiculously litigious environment, we do really well at it.
But for some reason, our MD colleagues feel it necessary to lie, defame, and manipulate the system in order to prop up their own profession by tricking Congress into legislating unnecessary referrals. Yes, they’re playing a game to trick you into making sure they remain one of the highest paying specialties out there. I hope you’re getting a nice fruitcake at Christmas for that.
Next: Do the right thing
Let me be clear, OMDs are great at what they do. They’re not nearly as good as we are when it comes to actually making people see, but they’re very good at surgery and medical management. That said, so are we. There’s endless data to prove that.
We could easily adopt a very cooperative relationship in which we do the medical management as we are taught in school or are comfortable handling in our respective offices, with referrals to them for things we aren’t comfortable handling or surgical intervention-but that’s not the adversary we face.
We face a profession that sees us as an inferior competitor. Now, mind you, they have zero objective data to back that up and rely solely on the “Well, they didn’t go to allopathic medical school” argument that they use basically against everyone (including DOs, although they’ve sort of given that up).
It’s weak. It’s sad. More importantly, it’s simply bad for patients. You’re supposed to care about that first and foremost. Do the right thing.
Next: We're too nice
Ahh…that felt good. Don’t get me wrong, I have no illusions that any optometric leader would pack me up in Hannibal Lector-esque gear and wheel me into the Congressional chamber and then unlock the door and run, but it’s a nice dream nonetheless. We should all be that guy or at least have leaders who utilize that guy.
The minute our feet hit the floor, the OMDs should think, “Oh, crap-they’re awake,” but we’re too nice. We always have been.
Dr. Oakey, while I respect your having completed medical school and obviously having done well to get an ophthalmology residency, you’re laughably green.
You’re a veritable child in the world of seeing patients, and I’ve forgotten more than you know about eyes, and the only reason you don’t know that is that my profession has tried way too hard to be friends with people who don’t deserve it.
You need to realize just how terribly wobbly and precarious is the pedestal on which you’ve placed yourself and your specialty and realize that we’re the ones buttering your bread. No OD referrals, no nice house and car.
Realize that, internalize it, and when you put on your big-boy pants, be a little nicer and respectful to your future partners in patient care.