Medical Model Muddle
Sight Gags by Scott Lee, O.D.
A common saying is “the times, they are a-changin’.” In optometry they have already changed. When I graduated from Illinois College of Optometry in 1977, my classmates and I were really good at refracting and fitting contact lenses, and some were really proficient with vision therapy and low vision. And we all knew to whom to refer when we encountered pathology, trauma, anomalies, etc. We were very well qualified optometrists.
Today’s graduates’ skills are somewhat suspect regarding refraction and they have little or no knowledge in fitting firm contact lenses. Their main interests are in what they are being taught—pathology, therapeutics, pharmacology, laser surgery, etc. Basically, they are junior M.D.s and no longer optometrists. And all the consultants are recommending adopting the “medical model” style practice. The only thing wrong with this new situation is the designation “O.D.”—and thus being junior M.D.s.
But why would anyone want to be a junior anything?
The obvious solution is to convert all the optometry schools to med schools and start awarding the more prestigious M.D. degree. With some of the new automatic refractors written about in glowing terms in some of our journals—accurate refraction down to 1/100th of a diopter and tied into free-form lenses ground to the same exact power—refracting ability appears far less important. And contact lens fitting has become so much easier that even some ophthalmologists could probably do it if they really tried.
This would eliminate all the O.D./M.D. controversy and would be a win-win situation for all—except patients, who would probably have to pay more for eye care.
But then, who really cares about patients anyway?
—John Clark Moffett, O.D.
Dallas, Texas
Getting Into Integrated Care
Regarding the olive branch from ASCRS, you make some excellent points. (
“An Olive Branch from ASCRS,” July 2012.) For decades I have had the strong belief that patient care and patient satisfaction are enhanced when optometry and ophthalmology practice cohesively. This is becoming an increasing reality as the number of optometrists and ophthalmologists who are in practice together continues to grow. Also, the future demand for eye care services will necessitate a market-driven approach to the delivery of care.
I have the distinct privilege of having been asked to join the IOMED (Integrated Ophthalmic-Managed Eye Care Delivery) task force committee, formed by ASCRS to help determine how this entire process will work, along with several highly respected and clear thinking optometrists and ophthalmologists.
Regardless of the outcome, you are exactly right: This is a promising first step.
Additionally, I am a big fan of Groucho Marx.
—Richard C. Edlow, O.D.
Lutherville, Md.
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