JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Distribution of Ophthalmologists and Optometrists in Louisiana and the United States
Peter Kastl, MD, PhD
Objective: to determine the distribution of ophthalmologists, optometrists, and their offices in Louisiana and the other states of the US, to test the assertion that optometrists outnumber ophthalmologists, thus needing surgical privileges to treat patients who cannot travel to a distant ophthalmologist. Methods: the Medicare Physician Compare National downloadable file was analyzed. “Isolated optometry offices” were identified as offices in a zip code that did not contain an ophthalmology office. The average distance to the nearest ophthalmology office was calculated. Results: there were 270 ophthalmologists in Louisiana with 634 offices, and 250 optometrists with 364 offices, meaning that ophthalmologists outnumbered optometrists by 8%, and by 74% in the number of offices. The average distance from isolated optometry offices to the nearest ophthalmologist was 13.1 miles.
Conclusions: Organized optometry has succeeded in getting a surgical law passed in Louisiana, claiming that optometrists are more numerous and rural than ophthalmologists. This communication disproves that claim.
INTRODUCTION
to allow optometrists to use dilating drops. 9 Next, optometrists lobbied state legislatures to grant them prescriptive privileges for therapeutic drugs, so that they could treat eye disease. They were successful in West Virginia and North Carolina in 1976 and succeeded in all states by 1996. 9 lobbied state legislatures and received surgical privileges in three states: Oklahoma(1998),Kentucky(2011), andLouisiana(2014).Whereas ophthalmologists must serve at least 48 months in a residency training program, of which 36 are spent in ophthalmologic training, to learn surgical techniques, optometrists in these three states can attend a weekend course to obtain the same privileges. More troubling, in Kentucky and Louisiana further surgical privileging is overseen by the state’s board of optometry; there is no physician oversight of optometric surgical expansion in these two states. More recently, organized optometry has The central arguments which organized optometry used to convince state legislators to grant them surgical privileges are that there are many more optometrists than ophthalmologists serving the public, they are located in remote areas where there are no ophthalmological services, and patients must travel long distances to reach an ophthalmologist, thus endangering their ophthalmologic health. Organized optometry has stated that it would be better for optometrists to be able to perform surgery themselves, rather than to refer to distant ophthalmologists. It is ironic that organized optometry couches this statement in terms of patient safety.
Quality care and patient safety are the two primary goals which drive hospitals, ambulatory surgery centers, physician offices, and most health care facilities to achieve excellence. 1-3 One aspect of patient safety is health care provider credentialing, whereby providers must prove they are competent to perform their procedures. 4-6 One legal way around credentialing is the push by paraprofessional providers to perform procedures or get legal prescribing privileges for which they are untrained. Because the United States does not have centralized credentialing laws, all it takes for paraprofessionals to be licensed to perform surgery is the ability to convince a state legislature and its governor to make them surgeons. The word “optometry” first entered the English language in 1859, 7 and optometry originated as a trade for measuring and prescribing spectacles. At this time optometrists worked under the licenses of physicians. Towards the end of the 1800s, optometrists lobbied state legislatures to become independent practitioners, beginning in New York in 1897 (unsuccessfully), achieving initial success in Minnesota in 1901, and finally achieving independent licensure in all states and the District of Columbia by 1924. 8 Optometrists later began lobbying state legislatures to allow them to use diagnostic drugs (dilating eye drops) in their practices.After twofailedattempts,RhodeIslandpassedenabling legislation in 1971 and Maryland became the final state in 1989
J La State Med Soc VOL 169 NOVEMBER/DECEMBER 2017 149
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