Let optometrists do eye surgery? That's going to be a no - American Medical Association

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Let optometrists do eye surgery? That's going to be a no American Medical Association

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[Ken Elder]

Didn't read the article but what else could they possible say?

 

[Michael W Ohlson]

We’re contributing to their arguments.

The applicant: seat ratio approaches 1:1.

I just watched a presentation citing lower OAT scores over time.

The first time taker pass rate on NBEO Part I, Applied Basic Science, while high at some colleges, is abysmal at others on the same test.

One state board’s reaction is to propose accepting a non-equivalent licensure test. The biomedical sciences are foundational to improved clinical decision-making and better outcomes in complex cases.

AOA trustees are reportedly suggesting optometry look for alternate testing. Thus, the suggested answer seems to be to artificially create higher pass rates rather than improve upon pass rates. This risks both patients and the public trust. Bad advocacy idea.

I also hear the test is just too hard, harming optometry. Words to the effect of: NBEO is protecting the public to the detriment of optometry have been reported. Let’s hope that isn’t viewed by the world.

There has been no increase in difficulty or shift to higher cut scores. Many candidates breeze through the exam. Most ultimately pass. The institutional report is on the ASCO site.

Procedures are learned by doing while under expert supervision.

Our state boards don’t require accredited CE. Perhaps they don’t know about standardized testing and accredited CE. But assuring initial and continuing competency of licensees is their job.

I write this while supporting enhanced scope for ODs. I simply see no reason for us to press forward with one aspect of a fight while running backwards on four other areas. We’ll ultimately lose in that way.

 

[Ken Elder]

We’re contributing to their arguments.

The applicant: seat ratio approaches 1:1.

I just watched a presentation citing lower OAT scores over time.

MCAT scores are remaining stable over time and this makes sense.

The number of medical schools in the country has increased about 10% in the past 25 years.

The number of optometry schools since I graduated 25 years ago is up almost 50%.

 

[Michael W Ohlson]

MCAT scores are remaining stable over time and this makes sense.

The number of medical schools in the country has increased about 10% in the past 25 years.

The number of optometry schools since I graduated 25 years ago is up almost 50%.

It’s not that difficult to sort through the data. Some is complex, but not all. Study has begun.

Thus far it reflects common sense.

NBEO (the finance cmte) presented a report to ARBO HoD. We compared ourselves to others, too. There were no pointed questions. We didn’t leave room for doubt. Everyone was invited to visit or ask more questions. Our entire presentation was based upon submitted questions, actually.

Arguing to avoid science testing, to use virtual proctoring for high-stakes licensure exams, bashing our small profession’s board exam due to the pass rates, making up weird conspiracy theories… jumped the shark. It’s very bad advocacy to increase doubt, increase angst, and lose the public trust. No one could make this up.

The lesson that will come out is that: 1) testing has known, demanded requirements in 2025; that’s reality; 2) if you take the top half of a pool, they score better; if you take the entire pool, some score far worse; 3) NBEO needed new IT and was charged with creating a new test; if you compare us to others, our spending is favorable; if you compare us by size, the numbers make sense; 4) being angry doesn’t make one correct; 5) NBEO is accountable to the public and to regulatory agencies; bring it; 6) NBEO demonstrates transparency via audits, 990s, broad cmtes, broad councils, the state board review cmte (NBERC), external psychometrics, external security, visitors/observers, a public member in governance, academics in governance, state board folks in governance… golly; 7) medicine, pharmacy, nursing, chiropractic, etc. create their nat’l licensing exams; so does optometry; that’s a plus, not a minus.

 

[Michael W Ohlson]

Aiming for the lowest bars and relying purely upon politics are losing paths for our profession.

Rhetorically, that statement gets twisted into bruised egos, saying I favor bureaucracy or tests, or that I’m self-loathing.

Nope, nope, nope. I favor ODs performing procedures.

Most folks expect competitive application processes, not 1:1 applicant: seat ratios. Most folks favor their HCPs having demonstrated a level of mastery of the relevant biomedical sciences. Optometry’s challenges are ours to recognize, acknowledge, and rectify. I didn’t list ignore, rationalize, or excuse, however.

The data is telling. The actions are telling.

The psychomotor skills necessary for SLT, PI, and YAG cap are not high. Understanding the rest of it takes knowledge and ability, of course. Procedures are usually learned by practice with expert supervision.

Most professionals would look at the data and act accordingly. Most advocates wouldn’t blame the NBEO institutional report on the nat’l licensure exam or seek out easier tests as a fix. That’s terrible advocacy (lost public trust) and makes no sense (indicates deep fear, not self-assurance).

Most ODs won’t place lasers in their practices or if so, not for quite a while. The DFE thread indicates not understanding dilation in 2025. I instilled gtt in 1986.

 

[Jeff Guthrie]

FYI this thread is not private, it is in the public forum.

 

[Michael W Ohlson]

FYI this thread is not private, it is in the public forum.

None of what I wrote is a secret. While Adam takes precautions, anyone can take a screenshot.

Posts on social media, the KBOE actions… all public. Institutional report (NBEO pass rates) and college data are on the ASCO website. Going backwards, the ABO federal court testimonies… public.

The dilation thing… every OMD sees it. ODs advertise “no dilation necessary.” Many habitually check a box that says: “Refused dilation.”

Social media posts are public and permanent. Discoverable. ODs’ posts on Facebook include making more money, saying they ignore record requests, money, calling pts names, money, admitting exam piracy (a crime), money, name-calling, money, saying they never dilate, money, customer/business, money, their boss won’t let them dilate, and quite a lot about money.

The idea that optometry is in a vacuum is silly. Also, we’re very small and such gossipers that there are no secrets. I became annoyed during the ARBO annual mtg, left, checked out, drove home. Then NBEO wanted me at another mtg. Drove back! I look forward to hearing the alternative hypotheses.

 

[Ken Elder]

None of what I wrote is a secret. While Adam takes precautions, anyone can take a screenshot.

Posts on social media, the KBOE actions… all public. Institutional report (NBEO pass rates) and college data are on the ASCO website. Going backwards, the ABO federal court testimonies… public.

The dilation thing… every OMD sees it. ODs advertise “no dilation necessary.” Many habitually check a box that says: “Refused dilation.”

Social media posts are public and permanent. Discoverable. ODs’ posts on Facebook include making more money, saying they ignore record requests, money, calling pts names, money, admitting exam piracy (a crime), money, name-calling, money, saying they never dilate, money, customer/business, money, their boss won’t let them dilate, and quite a lot about money.

The idea that optometry is in a vacuum is silly. Also, we’re very small and such gossipers that there are no secrets. I became annoyed during the ARBO annual mtg, left, checked out, drove home. Then NBEO wanted me at another mtg. Drove back! I look forward to hearing the alternative hypotheses.

I have never worked in an ophthalmology clinic.

What percentage of patients in a general ophthalmology practice refuse dilation? I imagine it's less than the average optometry practice but it sure as heck ain't zero.

 

[Michael W Ohlson]

I have never worked in an ophthalmology clinic.

What percentage of patients in a general ophthalmology practice refuse dilation? I imagine it's less than the average optometry practice but it sure as heck ain't zero.

The ODs and MDs all work for the hospital. Unique.

All of us get refusals. It’s not common, though.

The keys to acceptance are education prior to arrival and effective scheduling. Once the team and the practice population are on-board, it’s only an occasional issue.

If a practice is walk-ins or the pts do not expect DFE, it’s going to be a problem when it’s sprung on them. But it’s not really new, is it?

Fundamentally, the ODs are ignoring their educations in favor of the marketplace. 2025 minus 1986 = 39 yrs of mydriasis. Most of my experience is rural private practice. It’s not that hard.

Initial exam. Optimal stereopsis. Complete examination of ocular tissues. Document findings and a plan. Or not. I get that many choose not. I don’t see this as a crisis. The anecdotes and poor logic represent a problem with optometry. Others have problems; this is one of ours. I don’t actually get it, no. That’s fair.

Once state boards and advocacy begin avoiding biomedical science testing and causing harm over board exams, we have… oh, too late.

 

[Michael W Ohlson]

You know how the absence of basic streak retinoscopy and monocular refraction on the psychomotor skills goes over poorly with some? This decision was made years back. Years. Announced. Published.

I don’t mind if NBEO task forces revise this and place streak, spot, Mohindra, bell, and MEM retinoscopy with standardized pts (SPs) on the exam. Binocular refraction. Trial frame refraction. If that’s the result of focus groups, cmtes, task forces, SMEs, and consultants, fine. I’m merely a director. It’s not my call.

But, the idea that any OD skips dilation for sales, convenience, poor ability, fear of phenylephrine, belief in current 2D imaging, not knowing the reasons for mydriasis… yikes.

At least our state boards and advocates understand standardized testing and CE accreditation so that… oh, nope and nope.

I’m a little pissy today. None of these things are secrets, though. They’re quite public.