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Young Ophthalmologists
YO Spotlight: Milan Shah, MD

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For this month's YO Spotlight, we talked to Milan Shah, MD, who first came to our attention for his involvement in the 2008 Mid-Year Forum and Congressional Advocacy Day, part of his participation in the Academy’s Advocacy Ambassador Program. He discussed his passion for advocacy, especially regarding scope-of-practice issues. Dr. Shah is currently in a vitreoretinal surgical fellowship at Indiana University.

I have always been drawn to the sciences, and medicine is the ultimate science, with a bit of humanity thrown in as we work to make a significant personal difference in our patient’s lives. I chose ophthalmology specifically because I’ve always had an engineering mind, and ophthalmology was a field that had a lot of technology and engineering advances, as well as room for growth through technological advances. In this way, it is a great combination of diagnostic medical management and surgical intervention. It’s this combination of technology, science and diagnostic capabilities that makes ophthalmology truly fascinating.

I also had a very personal reason for specializing in ophthalmology — my paternal grandmother is legally blind in both eyes. Growing up, I saw how vision affects lives and limits options. I wanted to be able to change this.

During my first year of residency at the University of Florida in Gainesville, I started hearing and reading about events occurring across the country that involved issues such as optometric scope of practice and practice advances. I was astounded by the fact that optometrists were trying to obtain the right/professional credentialing to do something they had not been trained to do.

I weighed this with the knowledge that the eye is a very delicate organ, as well as the intimate experience I had with the amount of practice and training (both diagnostic and surgical) it takes to acquire the proper skills and finesse required to treat the eye. It was clear that what optometry was trying to do was ultimately a grave disservice to the patients.

America: Leader in Health Care?
What really bothered me, though, was that America is a leader in so many ways, yet in health care, we are not the leader by many standards. This was yet another blow: the idea of passing legislation that would give optometrists the ability to treat patients they are not qualified to treat. The very idea undermines the excellence in health care that America should be able to deliver.
This passion resonated throughout my residency and into my fellowship. It was the reason I wanted to attend this year’s Advocacy Day and Mid-Year Forum, which I was sponsored to attend by the University of Florida. I had the opportunity to visit Capitol Hill and meet with legislators. It was an extremely eye-opening experience and made me realize just how difficult this issue is.

The sad reality is that many legislators are very tired of the scope of practice issue, both within and outside the world of ophthalmology. The impression I got was that many of these folks just don’t want to deal with the “in-fighting.” They are frustrated with the entire thing. They’ve been dealing with medical scope-of-practice battles across the medical field, and to them it’s a small, petty issue. In their eyes, they just want care for patients.

However, what they fail to realize is the very distinct difference between the type of care that is delivered by an ophthalmologist and an optometrist, and how that can ultimately affect the patient. What they don’t understand is that, in some cases, no care is almost better than the wrong care.

Get Involved in OPHTHPAC
After attending the Mid-Year Forum, I also become involved in sending letters to congressmen anytime there is an issue that arises in a particular state, such as the recent issues in California. Additionally, I often have healthy discussions with my colleagues to get them involved in the OPHTHPAC organization, which is dedicated to advancing ophthalmology's interests at the federal level through its support of select Congressional candidates.

I am amazed by the astonishingly low number of Eye M.D.s who actually donate to OPHTHPAC, because the minimal donation is not much. Yet, every penny helps to invest in our future, careers and what we believe in … namely the level of care we provide. The way I see it, by standing behind our profession’s organization, we help to secure our futures and those of our patients.

Get Involved Today
That’s why I encourage all ophthalmologists, especially those like me just starting out, to, at the very least, join the Academy. I would advocate that they attend as many Academy meetings as possible, including advocacy meetings, especially the Mid-Year Forum and Advocacy Day. The more numbers we can show there, the more eyes we can open.

Next, I would strongly suggest that all ophthalmologists make the minimum donation to OPHTHPAC. There is no reason why everyone should not donate at least the minimum. It’s critical for the purposes our own profession, what we believe in and ensuring that we have a say in the legislation so that our patients get the best available care in this country.

I would also encourage all residents to get be involved on a much more local level -- both by joining their state ophthalmology society and, within their residency program, spawning discussion within their class, spreading knowledge to incoming residents and even having discussions among the faculty and informing them how critical the issues have become over the last five to six years. Every legal gain that optometrists secure when it comes to scope-of-practice is a huge detriment to our profession. The more ground optometry gains, the more ophthalmologists are undermined, and the more compromised the health and care of the patient becomes.

Lastly, I would encourage the Academy and state societies to continue to partner on strategies addressing some of the key arguments optometry is making regarding scope of practice. For example, when I attended the Mid-Year Forum, I learned that optometrists are claiming that there are so many areas of country that are underserved that they need to fill in the gaps.

However, of all patients seen in ophthalmology, only a very few are true emergencies. The majority of the things optometry is trying to do are procedures that are not critical. This means that, if they had to, a patient could reasonably wait and travel for the procedure, so the idea of an area being underserved is not a true issue. The Surgical Scope Fund is one of ophthalmology’s most powerful weapons against optometry’s bid for surgical privileges. The fund provides grants to state societies to support their legislative and public education efforts on safe eye surgery.

If there is any cause to believe in — the fate of our patients, our profession, our futures — this is it.

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