The Written Exam
In order to qualify for an oral examination, each applicant must pass a written qualifying examination. This is a multi-pie choice test that may cover any topic in ophthalmology and is especially devoted to the following subjects from the basic and cynical science course of the American Academy of Ophthalmology:
- Optics, Refraction, and Contact Lenses
- Retina, Vitreous, and Urea
- Neuron-ophthalmology
- Pediatric Ophthalmology and Strabismus
- External Disease and Cornea
- Glaucoma, Lens, and Anterior Segment Trauma
- Plastic Surgery and Orbital Diseases
- Ophthalmic Pathology
The Oral Exam
Upon successful completion of the written exam, applicants receive instructions for taking the oral part. Oral examinations are held twice annually at a time and place determined by the board. The oral exam is given by a panel of examiners during a one-day period. The examination is divided into six sections, and the emphasis is placed upon recognition of depicted or described abnormalities and diseases that affect the eye, ocular addenda, and the visual pathways, and upon the apathy of the candidate to synthesize clinical, laboratory, and histopathology data in order to arrive at a correct diagnosis. Candidates are expected to provide a reasonable and appropriate plan for medical and/or surgical management of the hypothetical patient. These examinations include developmental, dystrophic, degenerative, inflammatory, infectious, toxic, traumatic, neoplastic, and vascular diseases affecting the eye and its surrounding structures.
Candidates are expected to be competent in the following subjects:
- Optics, Refraction, and Visual Physiology. They should understand the essentials of visual physiology, including visual acuity, light and dark adaptation, accommodation and color vision, various forms of ametropia, principles and techniques of refraction, principles of lens design, and methods of correction of ametropia with glasses and contact lenses. Candidates should be familiar with the methods for prescribing protective lenses, absorptive lenses, and aids for low vision.
- Pediatric Ophthalmology and Strabismus. Candidates are expected to understand the anatomy and physiology of the neuromuscular mechanisms subservingocular motility and binocular vision. They should be familiar with the methods of examination for detection and assessment of sensory and ocular motor dies- orders. They also should know the clinical features, differential diagnosis, natural course, and management of the various types of deviations. They should be familiar with principles and complications of surgery upon the extra ocular muscles.
- Neuron-ophthalmology and Orbit. Candidates will be examined on the principles and techniques of various diagnostic procedures, including visual field testing, visual evoked responses, ultrasonography, conventional x-ray imaging, CT scanning, and magnetic resonance imaging. Candidates should be familiar with the clinical features, pathology, differential diagnosis, and management of various disorders of the orbit, visual pathways, coulometer systems, and pupillomotor pathways, including the indications for, principles of, and complications of orbital surgery.
- External Eye and Addenda. Candidates should know the anatomy, embryology, and physiology of the structures comprising the lachrymal system, lids, conjunctiva, and anterior sclera. They should demonstrate knowledge of the pathology, diagnosis, and therapy as well as indications, principles, and complications of surgical procedures to alleviate abnormalities and diseases affecting these tissues.
- Anterior Segment of the Eye. This includes the anterior chamber angle, iris, culinary body, and lens.
- Posterior Segment of the Eye. This includes the vitreous, retina, choroid, and posterior sclera.
Certification
Board certification is good for ten years, at which time an ophthalmologist must present proof of participation in continuing education programs and be in good standing with his or her state licensing board.
Salary and Outlook
A recent survey showed that ophthalmology ranked eleventh in a list of the top twenty-five physician specialties ingrowths. There are currently about fifteen thousand ophthalmologists in the United States. Their median net income iscurrendy about $165,000. The monumental gain in both income and growth has peaked, however. Medicare reimbursement for cataract surgery, the most popular of all surgical procedures paid for under Medicare, has been reduced twice in the past three years. A number of recent governmental studies have recommended additional reductions.
One such study conducted by Harvard University indicates that ophthalmology may witness a 40 percent decline in revenues. This study developed the Resource-Based Relative Value Scale for approximately two thousand services including many ophthalmic procedures.
The supply of ophthalmologists is expected to surpass the demand by the year 2000. Recent technological advances have eliminated the need for surgery, and many states are considering expanding the scope of practice for optometrists to overlap those of their M.D. colleagues. It is estimated that there are about two thousand physicians now involved entraining programs. The large number of new graduates plus the tendency among older physicians to remain in practice longer is expected to contribute to the "doctor glut" in this field of medicine.
Ophthalmologists are finding creative ways of counteracting negative market influences. One strategy uses the "if you can't beat them, join them" philosophy. The growing referral network between surgical ophthalmologists and optometrists is said to be the wave of the future. Many referral arrangements involve postoperative care by the referring optometrists, using a shared-fee reimbursement arrangement.
Some ophthalmologists who object to this type of cooperative arrangement have attempted to recapture the optometric dispensing market by locating their office next to stores that they own. They frequently employ opticians to run the dispensing operation in what is seen as a trend toward full-scope vision care centers.
Many doctors have objected to advertising in the past. However, optical superstores have been so aggressive in this arena that ophthalmologists must use all media including direct mail to court patients and referring physicians.
Although there may be an oversupply of ophthalmologists, there is not enough ophthalmic clerical and technical support staff to go around. Ophthalmologists are finding that these physician extenders are a necessity in increasing the productivity and profitabihty of a practice.
Finally, as the general public becomes better educated about the distinctions between the professional roles of eye care providers, ophthalmologists hope to see an influx of patients who understand the value of seeing a medical specialist for a serious problem. The National Eye Care Project, now in its fourth year, has gained widespread attention forts promotion of early prevention and free screening programs. As eye care consumers become more aware of the risks of eye disease and the benefits of early intervention and good quality care, they will have a better understanding of why and when to see an ophthalmologist.
