Optometrists forced to treat eye conditions as primary care

Dr. Doug Henry is a freelance ophthalmologist. He wrote this article for The Conversation. For many Ontarians with cataracts, bringing a doctor in to check their eye can be a lifesaver. But “procedure” often…

Optometrists forced to treat eye conditions as primary care

Dr. Doug Henry is a freelance ophthalmologist. He wrote this article for The Conversation.

For many Ontarians with cataracts, bringing a doctor in to check their eye can be a lifesaver. But “procedure” often takes the form of a costly trip to the eye doctor’s office.

Unless eye care is included in a doctor’s fee schedule for drugs, vision care and cataract surgery will not be included in many people’s health insurance plans. This can leave patients with conditions such as cataracts without the care they need, and at the mercy of eye doctors.

To be clear, it is not a shortage of eye care experts that is to blame for people lacking access to cataract surgery. It is a shortage of doctors willing to provide that eye care, or patients willing to pay a reasonable fee for it.

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The optometrist profession has decided that at least half of its physicians are needed to ensure patient satisfaction. Image Credit: Alamy

Optometrists, a relatively new profession in Canada, has grown rapidly over the past couple of decades and now provides basic eye care to up to 40 per cent of Ontario’s population.

But optometrists do not have the same access to patients as their more established counterparts. And the optometrists’ dispute with their much larger counterpart of eye doctors risks patients not receiving important eye care they require.

Until recently, optometrists were of the opinion that they only needed one or two physicians to handle patients, and they agreed with the use of only prescribed medicines in patients’ eyeglasses and contacts.

Not so. This was the result of eye doctors and eye care associations signing a memorandum of understanding that effectively licensed optometrists to practise like physicians and provide many of the same services. With the backdrop of that agreement came the requirement for one doctor to supervise a total of three optometrists.

To be clear, it is not a shortage of eye care experts that is to blame for people lacking access to cataract surgery. It is a shortage of doctors willing to provide that eye care, or patients willing to pay a reasonable fee for it.

That hiring by arrangement arrangement, sometimes called “company by-pass,” essentially created a back door for optometrists to run blind through to the practice of eye care. The agreement encouraged optometrists to buy services of doctors they saw once a year instead of signing up for the licensing and oversight of the Ontario Ministry of Health and Long-Term Care.

What would happen if someone who had cataracts went to a physician who was approved by Ontario’s new optometrist who were using the group agreement? He or she could be sent to some other physician who needed the same services who didn’t have an agreement with the optometrist. That would prevent the patient from actually getting their cataract repaired until the optometrist staff at Ontario’s health care provider called the ophthalmologist and signed an agreement that legally guaranteed them access to the patient.

This “set up shop somewhere and leave” potential for referral by a physician became known as the “loser-take-all” optometrist competition scenario.

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How patients would get the recommended cataract surgery or periodontal work performed is up to the optometrist.

That is the big problem. Over the past two years, our health leaders have been looking into this issue, including Health Minister Christine Elliott. The conclusion: Optometrists are being pushed into a situation where they are being used as a less expensive form of physician outsourcing.

We need to correct this situation quickly. Ontario needs to re-examine the optometrist-eye doctors’ agreement and ensure patients are able to get the needed services.

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