Who are we? I had to ask myself that the other day because there was a discussion on online optometry forum ODWire.org about how patients are more apt to see the nurse practitioner at CVS for their conjunctivitis than the OD. That evolved into all manner of unpleasant realizations about optometry.
Who are we? I had to ask myself that the other day because there was a discussion on online optometry forum ODWire.org about how patients are more apt to see the nurse practitioner at CVS for their conjunctivitis than the OD. That evolved into all manner of unpleasant realizations about optometry. The first is that it’s statistically true that people aren’t thinking of their eye doctor as the first person to fix their eye problems.
Private vs. corporate practice…again
I thought that perhaps the reason the public doesn’t think of optometry first was due to the old standby urban legend. Optometrists are not “real” doctors because they practice next to the turtle pools and dog food-if only we were in professional office settings, we would have more respect. I discussed that with a few of my friends, and this concept even started to gain some traction in my brain as I strolled by the $35 exam fee signs at the local retail store.
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But then I drove by a couple of what are considered to be upscale private practices in my area, and there was nothing but glasses as far as the eye could see. One of them was advertising an eye exam and progressive lenses for $99. I then made a point to drive by several of the private practices in the area, and the only thing you can see displayed are frames, lens specials, and pictures of fancy-looking women wearing expensive sunglasses.
Don’t get me wrong, those gals are very fancy, but that type of display doesn’t scream “medical care” to me. When you go on to OD forums, such as ODWire, ODs on Facebook, or the OptCom list, and the hottest topics are how to get your optician to score more second pairs and trunk shows, that’s a problem. There was a recent thread in one forum in which someone was asking for the hundredth time what we thought she should do on her trunk show. I suggested she call her neurologist and ask him what he did at his trunk show. She wasn’t amused, nor did she get what I was saying.
My next thought was to blame the American Optometric Association (AOA). AOA leadership is certainly a popular target these days. Let me be clear, I respect the AOA and its mission. While the state affiliates are knocking themselves out to try to carve out our place in a system that isn’t thrilled about our presence, the question is where is the national association? I guess my question to the AOA is: Where are the public service announcements? I hear spots from ophthalmology about seeing your ophthalmologist yearly if you’re diabetic, but nothing from us. Where are the guest shots on shows I detest like The Doctors and even daytime TV shows like Ellen? We can talk all day about image among ourselves, but just one 10-minute presentation on Dr. Oz being presented as an expert would move this profession forward a decade.
Why is the AOA not spending its dollars actually promoting the profession to the public by hiring people to get us out there? Where are the prominent, charismatic OD characters in shows like Grey’s Anatomy? Hell, the only thing I can think of is from five decades ago on Happy Days (Ralph Malph’s dad-for those who had actual babysitters rather than the TV set as children). So, I’d count the AOA’s participation in improving optometry’s image to be an epic fail.
The reality is that if we don’t have the public on our side, it really doesn’t matter what happens elsewhere.
I then looked at prescribing patterns among optometry and ophthalmology, and I found some numbers that are somewhat troubling. I read a study by Agustin Gonzalez, OD, analyzing prescribing patterns over a 52-week period.1 The data showed that 1,181,221 prescriptions were written by ophthalmologists, while 1,037,201 prescriptions were written by optometrists. Now, you might look at that and say, “Hey, we’re writing almost as many as they are! Yay us!” While I admire your ability to pound those lemons into a tasty drink, you have to remember that we not only outnumber ophthalmologists over two to one,2 we also provide over 85 percent of the primary eye care in the United States.2 Even having double the number of providers and providing the lion’s share of exams, we don’t even measure up.
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Lest anyone start grabbing the pitchforks and torches heading to my house thinking I’m saying that prescribing medications is the end-all, be-all of optometry or that I think I’m a “junior ophthalmologist” (a term I despise almost as much as daytime TV), I ask that you keep it in the context of our image. We don’t write very many prescriptions relative to the number of patients we see. That simply doesn’t jibe with the epidemiology. For example, a 2003-2004 Gallup Poll found that nearly 50 percent of Americans (that’s around 160,000,000, just to give an idea of the numbers we’re talking about) are affected by allergies, and more than 80 percent of these individuals reported ocular symptoms.4 When you factor in all of the other stuff we see, you have to wonder where all of the numbers are. Could it be that ODs are overlooking common medical concerns? Lack of DEA numbers means no reporting? Or are patients simply choosing us for glasses and going to the CVS Minute Clinic or PCP for their “real” medical care because they believe we don’t do that?
Here’s the skinny, my brothers and sisters: Times they are a changin’, and we either change with them or we become those nerdy guys with the white coats people used to see. The rise of refracting opticians, nurse practitioners treating eye conditions, vision plans and retail outlets murdering our materials revenue-all of these things point to one direction. We need to be the first providers patients think of regardless of what condition they have. And we must undergo a serious overhaul on our image. If we don’t take a look around our offices and ask ourselves objectively if we would think of us first for eye “stuff” beyond glasses, you can bet it won’t be long before the external threats of barbarians at the gate and internal threats like oversupply push us into antiquity.
1. Gonzalez A, De Paz C. 52 week analysis of allergy medication prescription writing by optometry and ophthalmology. Available at: http://www.aaopt.org/52-week-analysis-allergy-medication-prescription-writing-optometry-and-ophthalmology
2. American Optometric Association. The State of the Optometric Profession: 2013. Available at: https://www.aoa.org/Documents/news/state_of_optometry.pdf. Accessed: 07/23/2015.
3. Miller J. Step up your ocular allergy care. Review of Optometry. Available at: http://www.reviewofoptometry.com/content/d/allergy/i/1086/c/20384/. Accessed: 07/23/2015.