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Contacts and Kids
March’s Clinical Update (“Contact Lenses in Children: Getting It Right—Lens, Age, and Need”) is an excellent article. Children are some of our happiest patients; it can be very exciting to see children with unusual refractive errors dispense with their glasses and attain better vision than would be achieved with spectacles.
Fitting contact lenses correctly in children does indeed require skill on the part of both the ophthalmologist and a well-trained staff. An interested parent is also absolutely essential, since the parent must learn about the lenses, especially in young children who require assistance in inserting and removing the lenses.
The article’s advice for introducing cosmetic lenses to children based on their level of maturity is also very useful. However, I have been pleasantly surprised a number of times by young patients who did not initially appear to fit the pattern of responsibility that is considered so helpful in contact lens success.
And if a child “fails” at using contacts at a young age, it is very important to give them another chance later. The parents are certainly essential partners in the entire process and may contribute significantly to the success or failure of contact lens use in these younger children.
Frank J. Weinstock, MD
Boca Raton, Fla.
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Solving Ophthalmology’s Manpower Crisis
With insufficient numbers of ophthalmologists to meet the increased demand for ophthalmology services, an impending manpower crisis puts our patients at risk. We could solve this problem if we had physician extenders who 1) have a provider number so we can bill for services provided under MD supervision, 2) have a clinical medical background, 3) are willing participants in the MD-led health care team, 4) harbor no resentment toward ophthalmology, and 5) are not interested in practicing independently or engaging in activities for which they are not qualified. The practitioner who conforms to each of these requirements is the physician assistant (PA).
We need to look seriously at the PA as a valuable resource to help meet the increased workload in the coming years. There are 130 training programs for PAs in the United States and 5,000 graduates yearly. A significant number of the programs are affiliated with medical schools, but the required clinical rotations do not include ophthalmology, nor do any of the ophthalmology residency programs offer clerkships to PAs. Perhaps in the future such training opportunities will materialize.
In the meantime, ophthalmology practices can assist with familiarizing PA students with our specialty by contacting programs to offer their students a four-week clerkship. Such an experience would be invaluable in prompting these students to eventually work in ophthalmology. Until adequate training is offered during the PA training program, much of their experience would most likely be be acquired during several months of on-the-job training.
It should be noted that in the 46 years the PA specialty has existed, there has never been an effort in any state to achieve independent practice privileges—evidence, I believe, that the PA profession is sincere when they say that they are not interested in practicing outside of our supervision.
Seymour R. Rosen, MD
EDITOR’S NOTE: For a deeper look at this topic, including a discussion of reimbursement and PAs’ starting salaries, see Dr. Rosen’s editorial in Florida Ophthalmologist (Spring 2012). Go to www.mdeye.org and enter “Seymour Editorial” into the search field.
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