Scott A. Edmonds, OD, FAAO, focuses his blog on the role of the optometrist in health care reform – moving from primary eye care to primary health care. He is the chief medical officer of MARCH Vision Care, the co-director of the Low Vision/Contact Lens Service at Wills Eye Institute in Philadelphia and a member of the Primary Care Optometry News Editorial Board. 

Disclosure: Edmonds is a consultant for March Vision.

BLOG: Don't always expect new changes to make sense

The road to health care reform is not a straight line. There are twists and turns in the road, and even some dead ends and detours. With the amount of time and paperwork required, it would be nice if things could be better organized.

As optometrists, very few of the rules and regulations related to compliance are designed with us in mind. There are too few of us in administration and management roles and, instead, it is often those who have stopped practicing or perhaps were never involved in clinical care.

I was frustrated this month by the requirements to maintain my local hospital staff privileges. I have had privileges in this hospital for more than 35 years and, in that time, they have never quite figured out where optometry fits into their organizational structure. They understand ophthalmology and that they are a surgical specialty, and, as such, ophthalmology fits nicely into the department of surgery.

Back in the late 1970s, when they were first considering my application, I was affiliated with an ophthalmology group and I think that they assumed that I was kind of like a physician assistant, so optometry became a subgroup of ophthalmology and was housed in the department of surgery.

But times changed dramatically for eye care providers in a hospital setting. First, the ophthalmologists stopped doing surgery in the hospital surgical suite, and then they left the building completely and moved out to be closer to their ambulatory surgical center. Optometrists expanded their scope of practice and started providing medical eye care and then started to play an expanding role in systemic medical care and ordering more laboratory tests. My practice split from the ophthalmology group and rented space directly from the hospital and added more optometrists to the staff.

The requirements to maintain a staff position also changed. Initially, it was just a required flu shot each year, which made sense, but then web-based technology became available. The hospital, always wanting to stay a step ahead, developed a required online curriculum and test to be completed to keep the staff fresh and up-to-date. Again, this was a great idea from the 100,000-foot level but, as with most great ideas, the “devil is in the details.” So, last year, the first course came out for optometrists to maintain our staff privileges. You might have guessed it by now, “Safe procedures in the operating room.”