[7ontheline]

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7ontheline,

Here in Canada, Toronto specifically, ophthalmologists do not see patients without referals. There is no way they can. They are already so busy as is, there is no way they can accept patients just walking into their offices with any sort of ailments. Like our hospital emergency waiting rooms, which are filled with patients with colds and flus, MD offices would be filled with people with pink eye and styes and subconj hemes. This is where OD's come in.....we are here to rule treat minor problems and direct patients who need tertiary care appropriately. I think the problem is that MD's feel threatened by OD's increasing scope of practice.Maybe they should be, I don't know....we don't really have that problem in Canada. MD's can't seem to shake that image of optometrists from 60 years ago as a guy who only does refractions and knew nothing about pathology. Fast forward to 2006......many optometry schools have MD's on staff teaching OD's. DO you really think they teach us anything different than they teach med students? Do you really think that 4 years studying one organ is not enough to make OD's competent front line eye docs? Yes you see some cases from OD's that may be misdiagnosed, but there are way more that are correctly diagnosed. Perhaps we should ask OOT to tell stories about visits to their GP for non-ophthalmic health issues that are misdiagnosed and see if it's MD's are really that perfect. When an OD or chiropractor or other health care misdiagnose or mistreat, it's bc we're not MD's.....but when an MD misdiagnoses, there is backing from fellow MD's and coverups.

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We may agree about more things than we disagree about. I can't speak for the Canadian system, since I'm in the U.S. For things like styes, pink eyes, subconj heme, etc., I don't have any problem with ODs taking care of them. I do have a problem with optometrists taking care of things like glaucoma, for instance. I am a glaucoma specialist and I am amazed at how mismanaged it is in many optometrists' (and to be fair, many ophthalmologists') hands.

I think the problem lies in the term "primary eye care" doctor. What does that mean? The definition could be very broad or very narrow. Clearly optometrists get a lot of training in dealing with the eye, so to restrict them ONLY to refractions is a bit much. I do believe that ODs have tried to expand their scope of practice beyond what they are capable of however. Having worked with numerous OD residents, I have not been particularly impressed with their diagnostic or exam abilities. These are ODs who are through with school and legally allowed to go out and set up their own practice, and they fall below what I would expect out of a "primary eye doc." Of course everyone has different levels of competence and some ODs are extremely well-read and experienced. It's hard here in the U.S. though because the ODs attempt to reach for things for the entire optometric community, when many of them are IMO not trained properly for the expanded scope.