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Letters to the Editor

A Voice for All

Optometry and Ethics: A Query

Optometry and Ethics: A Reply

A Voice for All

I applaud the Academy for asking for feedback on the subspecialty certification debate (“Subspecialty Certification,” November/December). As the controversy has developed, the subspecialists have defined their positions via their individual societies, but there has been no clear voice standing up for comprehensive ophthalmologists. As the only society that incorporates the majority of comprehensive ophthalmologists in the United States, the Academy should represent that voice.

I am a comprehensive ophthalmologist practicing in an academic environment, and I cannot envision why any comprehensive ophthalmologist would support subspecialty certification. I do not believe subspecialty certification will correct the problem faced by oculoplastic surgeons, nor do I see the oculoplastic surgeons in my area having problems with privileges.

Of even greater concern is the silence from the Academy regarding subspecialty fellowship accreditation. While the Academy has asked for input from the specialty societies, where is the input on this issue from comprehensive ophthalmologists? Fellowship accreditation threatens the scope of practice of comprehensive ophthalmology and the quality of ophthalmology resident training. It also threatens the public welfare: Fellowship positions may decrease at a time when aging Baby Boomers will need more eye care. The safety net of county and public hospitals, already frayed and straining, may further deteriorate as positions disappear.

I ask that the Academy Council consider the welfare and concerns of comprehensive ophthalmologists as well as subspecialists in their deliberations over these matters.

Preston H. Blomquist, MD, FACS

Optometry and Ethics: A Query

I was approached by a pediatric ophthalmologist here in Honolulu. He feels that one reason optometrists are expanding their scope and encroaching upon ophthalmology is that ophthalmologists are teaching optometrists these skills. He would like to see the Academy act against those ophthalmologists who cooperate in educating optometrists.

Do you believe that it is in fact unethical for ophthalmologists to teach optometrists—and, if so, is this something that is appropriate for the Council or Academy to consider?

Jon M. Portis, MD

Ed: Dr. Portis is the Hawaii representative to the Council.

Optometry and Ethics: A Reply

There are both ethical and legal components to your inquiry.

With respect to the law, there is no law forbidding the teaching of optometrists (or, for that matter, nurses or ophthalmic technicians) by ophthalmologists. Moreover, if the Academy were to adopt a Rule of Ethics prohibiting the teaching of optometrists, that would create significant risks for the Academy under the antitrust laws.

If, however, an ophthalmologist is teaching optometrists to perform beyond their scope of practice, and the ophthalmologist is aware that those optometrists are practicing or intend to practice beyond their scope of practice under state law, then the ophthalmologist may be aiding and abetting the unauthorized practice of medicine. In such circumstances, the ophthalmologist could be subject to criminal prosecution and/or discipline imposed by the state board of medicine.

If an ophthalmologist is teaching an optometrist for a reduced fee or for free in exchange for referrals reimbursed under federal health care programs, that would have the potential to violate antikickback laws.

With respect to ethics, the Academy’s Code of Ethics will not come into play unless an optometrist is treating the ophthalmologist’s patients in a manner beyond the optometrist’s state license. If that is happening, it may be appropriate to refer the matter to the Academy’s Ethics Committee for review of informed consent issues (Rule 2 of the Code of Ethics) and an inappropriate delegation of services issue (Rule 7).

Many ophthalmologists are concerned that teaching optometrists will enable organized optometry to expand its scope of practice. The onus is on ophthalmologists in state leadership roles to stay abreast of optometric lobbying efforts and to proactively educate their state legislatures about the unique competence of the profession of ophthalmology.

Samuel Packer, MD
Chairman, Academy Ethics Committee

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