Dr. Sedgewick firmly believes that a much larger number of optometrists can develop their own practices devoted solely to medical treatment and build those practices very successfully. According to a recent Jobson survey of optometry practices, only 17% of visits and revenue generated by optometrists are medically related:
This number should be much, much higher. Having practiced as an optometrist for four years prior to entering medical school, and after building his own ophthalmology practice and working with a number of optometrists for the past 12 years, Dr. Sedgewick believes the main reason most optometrists refrain from developing their own Medical Optometry Practice is a need for more clinical exposure to disease. He believes that a consulting relationship between an optometrist and an understanding, empathetic, board certified ophthalmologist that truly wants the optometrist to succeed would enable more optometrists to build their own Medical Optometry Practice devoted solely to medical care.
Dr. Sedgewick’s goal in developing this ophthalmology consulting business is to help optometrists develop their own Medical Optometry Practice, not a practice working for or under an ophthalmologist, the so-called integrated model, but a practice that you own. The first three articles are about optometrists working for an ophthalmologist, and the last two articles are about an integrated model from an optometrist’s point of view.
- MDs and ODs Tout Integrated Eye Care Delivery Model
- Boost Practice Efficiency, Part 13 How to Integrate an OD Into the Practice
- Ethical Dimensions of Co-management
- What is ‘Integrated Eye Care?’
- Ophthalmology and Optometry: Working Together
- Professional Collaboration: Is It Worth the Risk?
Most strategies for having optometrists perform medical services involve the optometrist either working under an ophthalmologist or the independent optometrist has strict guidelines as to what they can and cannot treat, usually determined by the ophthalmologist. The scope is frequently less than what they can legally treat. This article is an example of optometrists working in a Florida health plan which allows O.D.s to provide “non-advanced” medical treatment. Who determines what that is? The article mentions optometrists performing medical treatment to the full extent of their legal abilities, but we wonder if that is true. The OD/MD Consulting Group would love to hear from Florida optometrists working under this plan about how much glaucoma they are allowed to treat free from ophthalmology oversight.
- Information About Primary Plus
While Dr. Sedgewick is aware that a small number of optometrists have already built their exclusive Medical Optometry Practice, he is also aware that a much larger number of optometrists, if they perform medical exams, perform medical exams only on their own routine eye exam patients and don’t receive many medical referrals from other optometrists. That doesn’t have to be the case. An optometric practice devoted solely to medical services is primed to take advantage of the huge numbers of retiring baby boomers as well as the expanded scope of practice laws that optometrists have been so successful in obtaining over the years. Between 1945 and 1964, 77 million baby boomers were born, which is about 4 million per year. The first group turned Medicare-age, age 65, in 2010. That is about 10,000 new baby boomers per day for the next 19 years! Here are two articles delineating the baby boomer demographics.
As mentioned above, having been a practicing optometrist for four years before entering medical school, Dr. Sedgewick believes his experience has given him an appreciation for the profession of optometry different than most of his ophthalmology colleagues. Ultimately, he would love to be involved, even if only in a small way, in helping to build a network of successful Medical Optometry Practices, coast to coast.
Organized ophthalmology societies, such as the American Society of Refractive and Cataract Surgeons (ASCRS) and the American Academy of Ophthalmology (AAO), have reached out to organized optometry in recent years, only to have the hand withdrawn. The first three articles explain this reversal. The fourth article talks about the reversal from an optometrist’s point of view, lamenting that it occurred.
- New Standards for the Annual Meeting: How They Came About
- AAO Letters: Can't Have it Both Ways & Fair and Relevant
- ODs, MDs Tout the Benefits of Working Together
- OD Ban from AAO Meeting Viewed as Unnecessary, Damaging
The demand for medical eye care has proven to be substantial. This need is the reason for the two sides of eye care to try and work together again. Here are seven articles revealing the desire for optometrists and ophthalmologists to work together in order to address the health care demands of the emerging baby boomers.
- Integrated Eyecare Symposium a Focus at ASCRS
- VHA Optometry Service Internet Website
- New Collaboration Between Optometry & Ophthalmology
- American Academy of Ophthalmology and American Academy of Optometry to Explore Educational Opportunities to Advance Quality Eye Care
- Ophthalmology, Optometry Academies Join Forces
- American Academy of Ophthalmology and American Academy of Optometry Announce Collaboration
- iFS Femtosecond Laser Technology Approved for Arcuate Incisions
The reasons for the reversal of AAO and ASCRS being withdrawn are complex as addressed above. The result is that the two sides are probably no closer than before. Dr. Sedgewick believes the main concern that ophthalmologists have with the independent medical optometrists is the perceived lack of clinical exposure most optometrists have to disease detection and treatment. Whether this point of view is justified or not is up for debate. It is true that the longer you are away from performing medical exams, your skills decrease significantly. Most organized optometry groups say that this perception by ophthalmology is due solely to the concern over the loss of revenue as optometrists expand into eye surgery. Optometrists performing surgery is a hotly contested issue and will probably be the “line in the sand” for organized ophthalmology. They will fight it strongly. Dr. Sedgewick will not get involved in the politics of optometrists performing surgery. There is too much medical care, especially for glaucoma, that needs to be addressed, and he believes the average optometrist can deliver this care with the confidence that a good ophthalmology consultant can provide. Further, surgical reimbursement for cataract surgery has decreased about 90% over the past 25 to 30 years, once inflation is taken into account. The money is no longer in eye surgery; it is in the clinic examining of chronic ocular conditions. Optometrists are fighting a battle that is going to be hard fought and not worth the reimbursement, or in Dr. Sedgewick’s opinion, worth the effort. The first article below is about the reduction in cataract surgery fees. The next eight articles are about the concern over optometrists performing “advanced” medical care and surgery and what happened at the Palo Alto VA Hospital.
- Avoiding Death by a Thousand Cuts
- The Co-management Conundrum
- The Glaucoma Foundation: Frequently Asked Questions
- Veteran Blinded by VA Optometrists Gets $250,000
- California Veterans Go Blind due to Bad Care from Optometrists "Practicing Beyond Their Scope"
- Two Veterans Settle for $650K with Palo Alto VA
- Unqualified Medical Providers Cropping up Under Obamacare
- Optometrists, Ophthalmologists Fight Over Eye Care Rights
- Why the Ophthalmologist and Optometrist Conflict Should Concern Patients
A look at what has happened in the past and what is happening in California today are examples of the continued difficulty the two eye care doctor groups have when figuring out how to work together. The first three articles are about California optometrists and their difficulty expanding their scope of practice in California. The last article mentions that today, optometrists cannot get on most medical panels, something that Dr. Sedgewick believes the California ophthalmologists are preventing. This has resulted in, as he has been told, ophthalmologists not being allowed on routine eye exam insurance panels in a tit-for-tat exchange.
- Ophthalmologists, Optometrists Don't See Eye-to-Eye
- SCCO Student Nicole Kohan Challenges: “How Will You Fight for Optometry?”
- California Bill Expanding Optometrists' Authority on Hold
- Glaucoma Certification Frequently Asked Questions
Optometrists are facing another contentious issue as (mostly) VA trained optometrists, with their expanded exposure to disease, are trying to become board certified as optometric medical specialists, distinguishing themselves from other optometrists. The American Optometric Association has fought this, believing that it will create two classes of optometrists – medically certified and non-medically certified – which might translate into only medically certified optometrists having the ability to get on medical panels. The following articles address this contentious issue.
- ABCMO Press Release: Faux Board Certifications
- House Rejects Plan for Certification
- How do I Earn Board Certification?
In summary, optometrists have the ability to perform medical care and, most importantly, glaucoma treatment in essentially all 50 states. The money in eye care is no longer in the surgical suite and has migrated into the clinic, treating chronic ocular conditions. Organized optometry is spending a lot of money and energy expanding into surgical care when the majority of optometrists don’t take advantage of the scope of practice abilities right in front of them. Obtaining referrals from fellow optometrists necessitates an optometric practice that does not offer routine eye exams or eyeglasses sales. Developing a medical practice also requires a large financial outlay for equipment while, at the same time, giving up the largest source of income for most existing practices: eyeglass sales. All of these factors present a challenge but also a large opportunity for select optometrists to develop a practice devoted solely to medical treatment – their own Medical Optometry Practice. This is something that is not occurring anywhere near the numbers that are possible. Dr. Sedgewick believes that this is due to a high level of uncomfortableness among most optometrists in treating more advanced chronic medical conditions. He believes, as a board certified ophthalmologist as well as a prior optometrist, acting as a consultant to support the optometrist is the answer.
Optometrists do not require an ophthalmologist to consult with them over medical decisions that they can legally perform in all 50 states, and yet, most optometrists have not developed their practices’ medical care anywhere near their potential. Dr. Sedgewick believes that a board certified ophthalmologist, one that was a prior practicing optometrist, with a true desire to see optometrists succeed in developing their own Medical Optometry Practice, could be the key toward unlocking this untapped potential for you.
In support of this goal, Dr. Sedgewick is hosting Part One of “Building Your Own Medical Optometry Practice,” a two-day lecture series to review the current medical knowledge for the 18 or so most common diseases the optometrist will likely confront, with an emphasis on glaucoma. He will use the Will’s Eye Manual and the Preferred Practice Pattern Guidelines as set forth by the AAO as the main reference sources. He will also pepper the lecture with examples taken from his own patients.
The lecture series will only be the starting point. For those optometrists that commit to building their own Medical Optometry Practice, independent of ophthalmology but with an ophthalmologist as their consultant, Part Two will consist of the optometrist traveling to Dr. Sedgewick’s Virginia office to review gonioscopy, scleral depression and a short list of other skills on live patients. With Dr. Sedgewick, you will then potentially sign a contract after a short vetting application of the optometrist. Dr. Sedgewick will be stringent on who he contracts with since his name will go on your charts, potentially exposing him to medical malpractice on your part, even though all of the decisions will be entirely yours. He will base his decision on your energy level, your grades from optometry school, your OKAP scores and references as well as a background check and credit scores. A residency is not required. A commitment is.
This first lecture series will be held Friday and Saturday, June 26 and 27, 2015 in Orlando, Florida at the Four Seasons Hotel. Reduced room rates ($349 per night) are limited as is the seating capacity of the lecture hall, so we encourage you to book now!
Dr. Sedgewick is very excited for this opportunity to help all of the optometrists that would like to start their own Medical Optometry Practice. In fact, if he had this opportunity presented to him before entering medical school, he would have built his own Medical Optometry Practice instead!