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Is Refractive Surgery a commodity? And other pitfalls
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SAN DIEGO - For the second year in a row the American Society of Cataract and Refractive Surgery has focused on the issue of refractive surgery as an industry and comanagement.
During the first Hallway Controversies Symposium of the 2001ASCRS meeting, 5 doctors and a laser vision correction industry insider debated the merits of the business of refractive surgery.
| Hallway Controversy moderator Stephen G. Slade, MD. |
In the first of three debates, J. Charles Casebeer, MD, and Daniel S. Durrie, MD, argued the merits and dangers of offering guarantees to LVC patients. While Dr. Casebeer did his best to be a proponent of offering guarantees to LVC patients, in the end he admitted that the notion of offering guarantees is a tenuous and dangerous proposition. He said that promising patients that they can expect 20/20 vision was something no doctor should promise, but he did say that promising your patients a lifetime guarantee is acceptable, as long as the surgeon is willing to back it up, all the way.
Dr. Durrie stuck by his position that no guarantee is a good guarantee. He felt that offering promises to patients was the perfect way to confuse and more importantly, perhaps break the law in many states. He pointed out that the very nature of advancements in age, techniques and technology meant that it would invalidate almost any guarantee a doctor could make.
In the second debate Richard Lindstrom, MD, and Jeffrey Machat, MD, delved into the pro and cons of the role of optometrists in the refractive market. Dr. Lindstrom explained that 60% of the LVC market prefer to shun ODs, while only the mid-level and “boutique” laser centers need ODs for comanagement reasons. Dr. Machat countered that he felt that the use of ODs in the refractive market would only increase in time, as discount laser centers went out of business and other doctors would need to bring in ODs to help with the increase in patients.
| Sideshow barker George Waring, MD, belittles the discount LVC industry in front of debate adversary Mike Hender- son, an LVC industry insider. |
Finally, in a often exuberant and very direct debate, George Waring III, MD, and former Lasik Vision executive Mike Henderson battled over the issue of whether or not refractive surgery is a commodity. Mr. Henderson, who left Lasik Vision more than a year ago, said that the cost and nature of LVC proved that it was a commodity. While he agreed that doctors were obviously integral to the industry, the actual procedure was nothing more than cosmetic surgery and could not be compared to more serious surgery, such as heart surgery.
When Dr. Waring’s time came to debate he ripped off his jacket, placed a hat on his head and grabbed his black cane and began to tout the LVC industry as if he was a side show barker, mocking the very industry model Mr. Henderson had once worked. Dr. Waring eventually pointed out that while it may be relatively inexpensive, that the LVC procedure still required the social contract between a surgeon and a patient. He explained that it was not a procedure to be entered into lightly and not something to be traded like gold and pork bellies.