Ophthalmologists Scope of Practice

An ophthalmologist is a physician (doctor of medicine or doctor of osteopathy) who specializes in the comprehensive care of the eyes and visual system. The ophthalmologist is the only practitioner medically trained and qualified to diagnose and treat all eye and visual system problems. Licensed by a state to practice medicine and surgery, an ophthalmologist is the only provider who can deliver total eye care. This care includes diagnosis of diseases of the eye and other bodily systems; comprehensive vision service, including prescribing medications, therapy, and corrective eyeglasses and contact lenses; plus medical and surgical eye care. The ophthalmologist has completed four years of college pre-medical training, four years or more of medical school, one year of internship, and three or more years of specialized medical training and experience in eye care.

Ophthalmologists are different than optometrists and opticians, who are not physicians. Optometrists and opticians are much more limited in the types of diagnostic and treatment procedures that they can perform.

Ophthalmology is one of the oldest branches of medicine. Greek surgeons were successfully operating on cataracts during the classical era. Today ophthalmology is one of the most technologically advanced of all medical specialties. Ophthalmologists are some of the leading experts in the development of laser surgery. Cataract extractions, which once required several days of hospitalization, are now considered "same day laser surgery."



Ophthalmologists can further define their scope of practice by choosing to develop special expertise in a sub-specialty within the medical specialty of ophthalmology. These are highly technical fields that require an extra two years of study and research at the fellowship level. The principal sub specialties of ophthalmology are: Comprehensive ophthalmology, Corneal/extra-ocular disease, Glaucoma, Ophthalmic plastic surgery, Neuro-ophthalmology, Pediatric ophthalmology and strabismus Retinal-choroidal- vitreal disease.

Areas of ophthalmology that have recently been recognized as new, emerging subspecialties include: Contact lenses Low vision aids, ophthalmic genetics, ophthalmic oncology, ophthalmic pathology, Uveitis.

Working Conditions

Ophthalmology, hake most health care professions, has become an industry. This means that today's ophthalmologists must be concerned with more than just being good doctors. Twenty years ago, ophthalmologists were secure in their role as the most expert of the eye care providers. They were the only practitioners who were closely allied with hospitals. The patients who came to their offices were referred by their family doctors or by friendly optometrists who accepted the traditional pecking order that delegated only dispensing of eyeglasses to optometrists and opticians. Ophthalmologists could expect to make a comfortable living by completing the required training and starting a practice.

In today's competitive environment, ophthalmologists are faced with competition from their former referral sources. Although they are still among the highest paid eye care professionals, income has become a variable factor in a changing workplace.

Ophthalmologists still enjoy a great deal of geographic mobility and can find employment in almost every area of the country. Osteopathic ophthalmologists are generally located near osteopathic hospitals, which are concentrated in Florida, Michigan, Pennsylvania, New Jersey, Ohio, Texas, and Missouri.

Ophthalmology is still one of the most popular specialties among young doctors. Compared with other surgical specialties such as thoracic surgery or obstetrics, ophthalmology offers a reasonable lifestyle with above-average income. Unlike other doctors, ophthalmologists rarely have emergencies that call them into surgery. Their workweek is similar to that of other nonphysical eye care professionals. Most ophthalmologists work between thirty-five and fifty hours a week. Modern technology has made it possible to perform ophthalmic surgery in the doctor's office or surgical center.

Solo and Group Practices

Most ophthalmologists are self-employed in private practices. However, as start-up costs increase, few young physicians see much future in going out on their own. Getting started now is likely to mean a less independent approach like:

• Buying an established practice
  
  
• Entering into an arrangement with a hospital
  
  
• Responding to recruiting by a rural community
  
  
• Sharing at least some facilities and functions with another colleague
  
  
• Cooperating with a number of other physicians in a “clinic without walls"
  

Pessimistic health care industry analysts predict that solo practice will be restricted to small towns and underserved areas. Rather than face the austerity of the start-up years, many young doctors will contract with hospitals and HMOs.Physicians in California and New Mexico have come up with solutions they think will help solo physicians and small group practices remain viable and independent. In both locations, physicians have formed their own corporations that provide a wide range of business services for doctors who want to remain in their own offices. The corporation spool expenses and achieve savings on purchases of equipment, medical supplies, bookkeeping, accounting services, health insurance premiums, and pension administration. Some groups even share office space, a receptionist, and medical technicians. In this "clinic without walls" scenario, a new ophthalmologist could share the overhead of starting practice with physicians in other specialties or with other ophthalmologists. Although starting a private practice is risky, most doctors still believe that the personal freedom it affords makes it all worthwhile.