Optometrists, ophthalmologists compromise on practice bill

Fights between medical doctors and specialists are legendary around the Capitol. This week, organizations representing optometrists and ophthalmologists say they are very close to a compromise on a set of scope-of-practice issues—including who gets to stick a needle in your eye.

Since February, the two groups have been sparring over SB 1406, a bill from Senator Lou Correa, D-Santa Ana. The bill follows a previous scope-of-practice battle between the two groups eight years ago. That bill, SB 929 from then-Senator Richard Polanco, expanded the number of procedures that optometrists, who are not medical doctors, can perform. But optometrists’ groups claim California law still limits their activities in ways that are onerous and endanger the health of patients, particularly those living in rural areas.

Ophthalmologists’ groups counter that SB 1406 was introduced as a “laundry list” of demands and would let optometrists perform tasks they haven’t been properly trained in—including eye injections and surgeries. They’ve also charged that the bill’s supporters tried to dodge the committee process by removing some provisions but then reinserting them before a pending floor vote.
Bryce Docherty, a private lobbyist representing the California Academy of Eye Physicians and Surgeons, characterized the changes as “a good faith agreement between all parties.” He added “It has been ophthalmologists intent to move forward from where were eight years ago.”

That agreement does allow optometrists to work their way towards being able to perform some procedures they could do in the past. This includes expanded abilities to diagnose and treat glaucoma, eye inflammation and other disorders. Optometrists gained new ability to offer topical treatments and develop treatment plans for patients.

But they were still left with little or no ability to perform injections or minor surgery. They were also left with a difficult certification path to actually practice the new tasks in their scope of practice, according to Tim Hart, government affairs director for the California Optometric Association. In order to be eligible, optometrists must complete 50 hours of additional training every two years, in association with an ophthalmologist.

“There are a number of things that California optometrists cannot do that optometrists in at least 42 other states can,” Hart said. He added that the law demands that optometrists refer any patients undergoing one of the covered procedures to also see an ophthalmologist: “It’s burdensome on patients because they have to see and pay for two doctors doing essentially the same thing.”
That’s precisely the point, said Dunbar Hoskins, executive vice president of the American Academy of Ophthalmology: ophthalmologists are doctors who have attended medical school and up to four additional years of specialized training. By contrast, optometry school requires half the amount of post-graduate education, only four years.

“The bottom line is, do you get trained trough education and seeing sick patients, or do you get your privileges through legislation?” Hoskins asked. “We think that dealing with sick eyes and sick patients is something that takes a long time to get right.”

Both sides agree that only about 130 of the state’s 5,800 optometrists have passed a two year certification since 2000—but disagree about why. Hart said a more straightforward path towards optometrists being able to offer more services is needed because there are far more optometrists in the state ophthalmologists, who number only about 2,300.

These ophthalmologists, Hart said, are “disproportionately centered in urban areas,” whereas optometrists are operating in 54 of California’s 58 counties. About two thirds of eye patients “see an optometrist first,” he added.

“Dentists are permitted to inject, to do surgery to the extranet it involves the teeth and the jaw,” Hart said. “It’s largely because they’re dentists are not in direct competition for patients with another specialty.”

Hoskins denied there was an ophthalmologist shortage, saying many members of his organization are actively seeking more patients. He also said the idea that there was an inherent conflict between the two fields was overblown; nearly half of ophthalmologists work in practices that also include optometrists, he said.

One thing optometrists do have is a man in the building. Assembly Ed Hernandez, D-Baldwin Park, is an optometrists and a past president of the American Optometric Association. Hernandez said he has talked to some of the parties about the bill, but is not directly involved.

“I haven’t lobbied any members,” Hernandez said. “I do think optometrists need to expand their scope of practice.” 

Meanwhile, the rivalry between the two groups will is also playing out in an Assembly Republican primary.  The group Doctors of Optometry for Better Health Care has contributed $153,000 to support another optometrist, Scott Kamena, who is running for the Republican nomination to replace Assemblyman Guy Houston, R-San Ramon.

The California Academy of Eye Physicians and Surgeons PAC has given $3,600 to one of Kamena’s opponents, Judy Lloyd. She also received $7,200 from the California Medical Association’s Small Contributor Committee.