The Scope-of-Practice Quagmire

A Like many other medical specialties across the US right now, ophthalmology and optometry are at odds over scope-of-practice issues. Two recent and opposing actions have recently stoked this long-standing struggle between the two professions: (1) organized state optometric societies have pushed for legislation to increase optometrists' scope of practice into areas traditionally considered to be the realm of medicine; and (2) the AAO and the ASCRS recently decided to disallow doctors of optometry to attend their annual meetings unless these practitioners are employed by ophthalmologists or the ophthalmic industry.

In this issue of Cataract & Refractive Surgery Today, we wanted to present opinions from both sides on the sensitive issue of scope of practice. We explored the status quo and postulated how and by whom patients' medical and surgical care will be provided in the near future within individual states. Should ophthalmic surgery only be performed by ophthalmic surgeons, or is it appropriate for an optometrist to perform surgery with a laser or scalpel? Is ophthalmologists' traditional course of medical school and structured ophthalmic residency training overkill? Do patients understand the difference between an optometrist and an ophthalmologist? Do they recognize the differences in didactic training, resident experience, and supervised medical and surgical care training in an accredited training program? Are some groups taking advantage of their professional titles and of public ignorance to further personal agendas? The answer appears to depend upon whom you ask.

In the debate about who is best suited to perform ophthalmic surgery or operations in other surgical disciplines, the argument may be more about what the minimal educational requirements are for operating on a human patient. Frighteningly, there is a danger that the merits of education and supervised training may be trumped by which interest group's argument, debating skill, and political/financial contributions are most convincing to individual state legislative bodies. If optometry groups' stated goal is to create a parallel or parity profession, is it appropriate that the “equal” professions be licensed and credentialed through separate boards within a given state? In most states at present, medical doctors, doctors of osteopathy, doctors of podiatric medicine, and doctors of chiropractic fall under the auspices of the specific state board of healing arts. Optometry falls universally under its own board and acts totally and unequivocally independently of state boards of healing arts. Why? What does this arrangement allow or disallow? Should it concern the public and practitioners? These and other considerations are raised in this provocative issue of CRSToday. As always, we welcome your comments at mail@bmctoday.com.