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What advice would you offer ophthalmologists who are working in an integrated eye care model?
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Ophthalmologists should be open-minded
 Louis D. Nichamin |
Remain open-minded and be willing to think out of the proverbial box. I think that we, understandably, tend to view this issue with deep-seated, rather visceral feelings about the differences between the two professions. The reality is that most practitioners in both ophthalmology and optometry are dedicated individuals concerned with applying their respective knowledge and training toward the care of patients with eye problems. The delineation between the fields has changed in recent years and regardless of whether a surgeon likes that or not, one has to deal with it and do what one ultimately feels is in the patient’s best interest.
I think that we, in our profession, tend to look at change negatively — that change, by definition, is pejorative. The medical socioeconomic milieu, however, is anything but statis. Our willingness, motivation and ability to keep up with this change on so many fronts can be a significant challenge, but the fulcrum of this “see-saw” will always balance upon the need to maintain and provide quality care. As long as we adhere to that aphorism, within limits, how we deliver that care can be an ongoing dynamic, dependent upon societal, cultural, and to some extent economic influences.
If an ophthalmologist has not previously integrated their practice in some way with optometry, for whatever reason, I think that he or she is increasingly feeling the need to do so. For many, the decision may be to continue to maintain independence, and that’s certainly reasonable. But for others, the choice to integrate their practice should also be considered acceptable as long as it is done so in an ethical fashion wherein the patient’s best interest is held to be of foremost importance. Despite growing economic pressures and realizing that it may sound trite, the fact is that most surgeons and optometrists alike embrace an unmitigated desire to do what’s in the patient’s best interest. Open-mindedness and common sense need to prevail.
Louis D. “Skip” Nichamin, MD, is an OSN Cataract Surgery Section Member.
Communication is key
 John A. Hovanesian |
The best advice for ophthalmologists who wish to integrate eye care with optometrists is to “train them, trust them and let them shine.” Our private group ophthalmology practice, Harvard Eye Associates, is located in southern Orange County, Calif. We enjoy a highly discerning patient population and a high rate of adoption of premium lens implants, LASIK and cosmetic oculoplastic procedures. We depend heavily on integrated pre- and postoperative care with optometric colleagues, both in and outside our practice. Patients genuinely see added value in having a team of doctors — subspecialists — who are responsible for their care.
We achieve this added value through training and constant communication with our optometric colleagues. We constantly engage in “curbside consults” about outcomes, treatment strategies and communication with patients. We hold weekly educational conferences and quarterly grand rounds, which delve into the finesse of patient care. This open-ended communication has grown our mutual trust and respect, and we — the ophthalmologists — often find we are the recipients as much as we are the providers of knowledge.
Whether we like it or not, integrated care with optometrists is likely to become part of everyday practice for most ophthalmologists in the U.S. in the coming years. When you consider the growth in the aging population and the relatively steady-state of the number of ophthalmologists, it’s simply unlikely that we as surgeons will be able to manage pre- and postoperative care for all patients by ourselves.
Ophthalmology is not the first specialty to integrate patient care. Our colleagues in cardiothoracic surgery, orthopedics, neurosurgery and even internal medicine have for decades depended on physician assistants and nurse practitioners to supervise routine and even non-routine care. Why should ophthalmology be different?
John A. Hovanesian, MD, is an OSN Cornea/External Disease Section Member.