Eyeworld

EW FEATURE January 2011 39 Cornea, retina, general ophthal- mology, and refractive-only prac- tices, however, use the integrated model pretty well. "A refractive-only practice, where they are doing LASIK and nothing else, almost always em- ploys an optometrist because the re- fractive surgeon wants to do surgery and doesn't want to spend time doing a lot of post- or pre-op exams," Preece said. If a practice decides the need is there and hires an optometrist either full or part time, there are a couple of ways to begin encouraging pa- tients to see the optometrist for their routine needs with varied strictness. The first is to have the recep- tionist ask the patient whom they would like to see without encourag- ing either way. Preece strongly dis- courages practices against this method. "When this happens, the optometrist ends up seeing six or seven patients a day, and the oph- thalmologist is still seeing 50," he said. The second technique still gives patients a choice, but includes some encouragement to see the op- tometrist from the scheduling staff. When a new patient calls, they would automatically be offered an appointment with the optometrist. If an established patient calls and the new model was put in place since their last appointment, the re- ceptionist would explain they could see the optometrist immediately but will have to wait for the ophthal- mologist, and leave it up to the pa- tient to decide. According to Preece, in most cases the patient will want the closest appointment and just take the slot with the optometrist. "Years ago, it was very difficult to get patient's to agree to see an op- tometrist because there was this feel- ing that they weren't quite doctors," he said. "Nowadays, it's not as hard, but you have to train the reception- ist what to say. You have to give them a script and make them use it." The third and final method is the strictest of them all. Here, the ophthalmologist is completely over- whelmed with routine exams and wants to focus on pathology and surgery only. In these practices, the patient is told that everyone, new patient or recurring, has to be seen by the optometrist and will only go to the ophthalmologist on a referral basis. In addition to hiring an op- tometrist, some integrated practices will choose to add on an optician to fill a patient's glasses prescription. "An optician will send out the frames with the order to the lab," Preece said. "They'll help the patient fit glasses, adjust the frames on the patient's face, and measure for bifo- cals if the state allows it. It can take a half hour to fit glasses on a pa- tient. You don't want an ophthal- mologist or an optometrist spending that kind of time." Hurdles Pinto and Preece both estimate it will take a practice about a year to become comfortable with the inte- grated model. "It takes that long to get to know the optometrist and for the staff to get accommodated," Preece said. "The optometrist needs to figure out what the patients needs are, and what and the ophthalmolo- gist expects." Depending on the ophthalmol- ogist's personality, management style, and level of trust expectations can widely vary. As Preece points out, some ophthalmologists will have no problem handing over rou- tine eye exams to the optometrist, but others will want more control. "The ophthalmologist has to be committed to allowing the op- tometrist to practice to the full ex- tent of their licensure," Preece said. "A few practices I've dealt with have hired an optometrist but the oph- thalmologist still wants to see every patient. The optometrist works the patient up like a tech, but at a much higher price. That's a very expensive way to see patients." Having confidence in the op- tometrist is sometimes the biggest hurdle practices face when using the integrated model, which is why hir- ing the right optometrist is crucial. "The best optometrists tend to be in the top 10% of their class," Pinto said. "They are energetic and effi- ciency minded. They are affable and patient loving. When you have an optometrist will a full package like that, they work out just great." "Some ophthalmologist's will argue that it might be cheaper to have an optometrist do an exam, but it won't be as high quality," ex- plained Preece. "That's a good point, but if it's a routine exam and the pa- tient just needs glasses or new con- tacts, most ophthalmologists will agree that the optometrist can do just as good of a job." Thankfully, the idea that op- tometrists and ophthalmologists shouldn't be working together is fad- ing out of fashion, says Pinto. "Those ophthalmologists who feel integration is the wrong direction, or feel that ophthalmologists should not practice with mere optometrists should be allowed to go their own way. I think it's clear now and has been for some time that that way of thinking is not the mainstream," Pinto said. "Twenty years ago we probably found one out of 10 ophthalmology practices had an optometrist," he continued. "Now, I'd estimate that a quarter to a third are integrated practices. I think it would be a rarity 20 years from now to find an oph- thalmology practice that didn't have at least one optometrist. "When you have legal and economic drivers on your side, you have change." EW Editors' note: Mr. Pinto and Mr. Preece have no financial interests related to their comments. Contact information: Pinto: 619-223-2233, pintoinc@aol.com Preece: dpreece@bsmconsulting.com 4UFXBSU$PVSU%FOWJMMF/+t64" ttXXXLBUFOBDPN Polishers for a clean capsule Katena Henderson MICS Capsule Polisher Henderson, Bonnie to cannula this cells emaining r capsular or posterior 2.2mm a ough thr 1.25mm ed textur Henderson MICS Capsule Polisher designed MD Henderson, any debride help , anterior the om fr surfaces nix for capsular nely The incision. 2.2mm disc-shaped wide 1.25mm Henderson MICS Capsule Polisher Shepher 1.25mm ed textur gentle permits tip o r h t n o i t a g i r r i keeps port posterior chamber formed. d Polishing Cur Shepher disc-shaped wide 1.25mm while scrubbing gentle m m 3 . 0 s t i h g u o anterior the keeps ette d Polishing Cur K3-1102 featur ette cur This which tip ring 2mm semi-sharp The sides. both polish to used e ar portions posterior ensur design ring The distributed is contact educing r ea, ar surface inadvertant capsule ruptur ole pr low a es on beveled is which edges semi-sharp and anterior the capsule. the of capsule that es ensur ger lar a over distributed of chance the educing e. inadvertant capsule ruptur f Po Kraff Posterior Capsule Polisher 1.75mm delicate This designed is ette cur cup any debride and posterior the on Irrigation capsule. facing d downwar surface capsular f Posterior Capsule Polisher closed 1.75mm polish to designed cells emaining r the of surface the ough thr Irrigation the keeps port evenly for taut f Posterior Capsule Polisher contact distributed outer ring. the with contact K7-4880

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