Overtrained O.D.s?

BY JOSEPH T. BARR, O.D., M.S., EDITOR
JUNE 1996

Many optometrists believe that ophthalmology is putting educational hurdles in front of O.D.s who are undergoing TPA training. They believe this is an attempt to delay delivery of care to the public by optometrists, and thereby keep patients under the ophthalmologists' and other M.D.s' management.

California recently erected a daunting set of hurdles. There, optometrists (no more than three at one time) must train with an ophthalmologist "preceptor" for 65 hours. Why does the state require so many hours of "apprenticeship" for such a limited law?

Other healthcare professionals, especially pharmacists, agree that this requirement is excessive. They see how many prescriptions are written by (non-ophthalmologist) medical doctors who may be less qualified than O.D.s to treat ophthalmic conditions.

As we all know, O.D.s are generally overtrained for the procedures they're licensed to perform. So much so that most states have ruled out the need for them to undergo further clinical training by ophthalmologists for TPA certification. I've never noticed that California optometrists were less gifted than those in other states.

I realize it's hard for ophthalmologists to understand that O.D.s are competent to treat ocular disease, just as it's difficult for many O.D.s to understand that there are competent non-O.D. contact lens practitioners.

There's no monopoly on knowledge, experience, wisdom and judgment. Professionals in both disciplines possess these qualities, just as members of both groups may not be willing to incur undue risk. It amazes me that some ophthalmologists assume O.D.s will treat conditions they aren't competent to treat. Even in states where O.D.s are permitted to treat glaucoma, they're taking their time to learn more about the procedure before they begin treating because they want to be confident of their abilities.

We need cooperation in the eyecare field. Ophthalmologists who are welcoming the opportunity to train O.D.s in their offices and clinics will build strong, trusting relationships and will gain referrals from these trusted colleagues. This, of course, will ultimately work toward the public good. But if we put up hurdles just for the sake of putting up hurdles, we're no longer considering our patients' needs.

There are larger challenges than optometrists being allowed to prescribe drugs -- limited research dollars, managed care, control of patient care by insurance companies and vision care plans, to name a few. Hopefully, in the future, optometry, ophthalmology and opticianry can work together -- all in the best interests of the patient. CLS