
Optometrists Feel Threatened by Technology, So Guess What They Do - walterbell
https://www.forbes.com/sites/georgeleef/2017/06/13/optometrists-feel-threatened-by-technology-so-guess-what-do-they-do/amp/?__twitter_impression=true
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dailyvijeos
I have perfect vision now but massive genetic risks for ARMD and glaucoma;
when I get much older, blindness is likely without proper lifestyle and care.
I’m fine with periodically going to optometrists who’s expertise will catch
such issues. I can understand people whom have stable prescriptions not
needing expertise all the time, but effectively decimating optometrists would
be a horrible idea. As a diversification of risk, optometrists need to
specialize and/or get side businesses because automation will incessantly
nibble away at every profession and risk institutional wisdom that isn’t
easily rebuilt.

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asddkk
Part of the problem is that this regulation works from the other side too, but
doesn't get as much attention. Optometrists have been trying to expand their
practice into other areas in ways that seem reasonable to me, but then
physician groups start to wield FUD tactics to stop them.

So what should happen is smartphone app provides another option, optometrists
shrug because they have so many other things to offer, physicians shrug
because they have other things to offer, etc.

But what's happening instead is the physician groups are staking their turf,
and the smartphone apps are coming out, and optometrists are kind of squeezed,
and fight back in all directions.

The problem isn't that optometrists aren't capable of offering other services
in a capitalist-competitive sense, it's that licensing regulations are
preventing those services from existing.

If the congress wasn't so busy in some damn pissing contest over payments in
the health care system, they might try to enact more structural improvements,
like massive licensing deregulation.

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walterbell
Do you have some examples of proposed OD practices blocked by MDs?

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asddkk
It depends on the state, but what I've read of so far is mostly expanding the
range of eye diseases that can be treated with medication, and expanding their
prescription privileges. Some of it focuses on lasik surgery, which probably
merits more scrutiny, but certain states already allow it.

E.g.,

[http://www.sacbee.com/opinion/op-
ed/soapbox/article75185362....](http://www.sacbee.com/opinion/op-
ed/soapbox/article75185362.html)
[https://www.reviewofoptometry.com/article/new-york-ods-
push-...](https://www.reviewofoptometry.com/article/new-york-ods-push-for--
expanded-practice-scope)

Here's examples of discussion from the physician side, which tends to be a bit
more FUD-focused, and to be biased in how certain topics are approached:

[http://journalofethics.ama-
assn.org/2010/12/pfor1-1012.html](http://journalofethics.ama-
assn.org/2010/12/pfor1-1012.html)
[https://jamanetwork.com/journals/jamaophthalmology/fullartic...](https://jamanetwork.com/journals/jamaophthalmology/fullarticle/2664079)

One of the articles starts by discussing psychologists, where similar issues
arise. The typical AMA/physician group argument goes like this:

Profession X has specialized training in area A but limited to that, and not
in area A+B. Physicians, in contrast, have training across a wide scope
including B, and then in addition specialize in A.

The problem with this argument is that it presupposes that the only way to
obtain training is by going from B, and then adding A, and ignores the
argument that one could go from starting with A and then adding B.
Optometrists aren't saying "everyone should be able to do lasik, or prescribe
everything without training," they're saying "we are qualified to learn how to
do it." Psychologists aren't saying "everyone with a license should
prescribe," they're saying "people who have a license and then get additional
training can prescribe."

The other problem is the physician groups tend to vastly undercharacterize the
amount of training that often accompanies e.g., psychologists or optometrists.
A psychologist was recent interim head of the National Institute of Mental
Health, and many of them do research in psychophysiology, interventional and
observational brain imaging, pharmacology, and so forth, and enter with the
bio backgrounds. Conversely, the amount of actual coursework in medical school
is increasingly less and less, and because they are covering so many areas of
medicine, the amount of training they get across areas is relatively small.

My point isn't to belittle MD training, it's just to say that people have to
be careful in the assumption that going from broader -> specific is
necessarily better than going from specific -> broad, or that you have to
start with certain education and then specialize, as opposed to picking up
additional education along the way.

The issue is really a monopoly of (a) specific educational and training
model(s) in the health care setting. Licensing is not actually competency-
based, it's credential-based.

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BugsJustFindMe
So is this an ad for Opternative?

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mikestew
It worked, I’m looking at their page right now. And you know why? Because
optometrists have been so hit-or-miss for me that I can’t see why a phone app
doesn’t have shot at doing just as well.

