Optometry has been winning big lately, and ophthalmology doesn’t like it. Think of all the scope of practice gains optometrists have notched in just the last few years. Laser procedures are on the cusp of going mainstream in optometry, with 10 states cleared and more in hot pursuit. Incisional and injectable procedures for lid lesions are already there.
At the national level, the Veterans Affairs Administration is pushing to get its optometrists parity with ophthalmologists and other MDs in administrative responsibilities and salary. The VA is also still working on a plan to set its own national standards for optometric scope of practice that would supercede any state optometry laws that don’t meet the VA’s. That one hasn’t been rolled out yet, but will have a seismic effect on state-by-state scope battles once it does, since it’ll set an appropriately high bar for the definition of optometric practice—one sanctioned by a respected federal agency. It’ll get name-checked on every state scope bill going forward.
All this isn’t quite on par with blowing up the Death Star, but the behemoth institutions of organized medicine, seeing threats to their power everywhere, are rattled nonetheless. Their counteroffensive includes the usual hatchet-job-in-local-newspaper stories that innocently claim to “help the public understand which eye doctor to see” to but then invariably paint a picture of optometry circa 1987. The most recent, and most deplorable, tactic has been a series of proposed state laws that would restrict use of the word “physician” to those practitioners with an MD or DO degree.
Ostensibly, these are being proposed to clarify the boundaries between doctors of medicine and osteopathy and, well, everyone else—nurse practitioners, physician assistants, chiropractors, podiatrists, optometrists. Anyone in the health professions who lacks an MD or DO after their name gets second-class citizen status.
The question is: why? Is there any demonstrable harm to public safety from the title a certain doctor uses? Nope, it’s just gatekeeping. Ophthalmology fears the loss of its pre-eminence in the face of a growing, thriving profession of eye doctors—one double its own size—that it has no control over. So, let’s be clear: this is about pettiness, not patients. Though these laws cover many healthcare disciplines, the ophthalmology groups that encouraged this effort just want to create a demeaning experience as payback for the optometry profession’s hard-earned gains in skills and scope.
In the news section of this month's issue, you can read about Florida’s attempt to block optometrists from the use of “optometric physician,” and you can always find the very latest news online on our News Feed, updated daily. As of press time, this gambit by the medical lobby failed to withstand vocal opposition from optometrists in Florida, who successfully got an amendment added to protect them.
Turf wars are tiresome, and they belie the strength of one-on-one relationships between thousands of ODs and MDs in the trenches that are productive and marked by mutual respect. But until the institutions of medicine see optometrists as an ally and vital part of their own future success, the battles will continue. Man the X-wings.