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Patients’ best interests should dictate scope of practice
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The state of Louisiana recently expanded the scope of practice for optometrists to include performing limited laser procedures. This could not be a more divisive issue. Those who favor expansion of optometric scope of practice would label it a win for patient access, whereas those against such laws would argue that less-than-qualified individuals will be performing surgery.
Indeed, there are parts of our country where patient access to qualified ophthalmologists is limited. Otherwise, there would be no need to consider such laws. But do these laws really compromise patient care? If we consider a patient’s best interests, there may be very rare situations where someone other than an ophthalmologist should reasonably perform eye surgery — such as when a remotely located patient is simply too ill to travel to a medical doctor’s care. Even in such remote locations, though, will rarely be found a traveling laser without an accompanying ophthalmologist.
Patients’ best interests, not political or financial motivations, should guide laws on scope of practice. Those of us who perform surgery have learned the hard way that complications can happen to every surgeon and every patient. They can be profoundly impactful on a patient’s life, and they are extremely humbling and challenging to the surgeon, even after preparation with 4 years of medical school, 4 more years of ophthalmology residency and 1 to 2 years of fellowship. A course for non-physicians in how to set, aim and fire a laser is simply no preparation for handling all the complexities that can turn a simple surgery into a patient’s and doctor’s nightmare. The rural patient, who would be most likely to receive surgery by a non-physician, has the least access to the advanced care needed when a complication happens.
Where my partners and I practice in southern California, there is no shortage of ophthalmologists, yet we have for decades been at the forefront of working with optometric colleagues and promoting their involvement in advanced care. Still, I very much worry for patients’ best interests when surgical privileges are granted based on legislative fiat rather than the time-honored process. It’s for good reason that quality surgical care is based on medical school training followed by many years of supervised practice under an educational-limited license as part of an academic medical center. Learning how to push the buttons is no substitute for this experience that comes through time, mentoring and many, many supervised procedures.