[asddkk]

Part of the problem is that this regulation works from the other side too, but doesn't get as much attention. Optometrists have been trying to expand their practice into other areas in ways that seem reasonable to me, but then physician groups start to wield FUD tactics to stop them.

So what should happen is smartphone app provides another option, optometrists shrug because they have so many other things to offer, physicians shrug because they have other things to offer, etc.

But what's happening instead is the physician groups are staking their turf, and the smartphone apps are coming out, and optometrists are kind of squeezed, and fight back in all directions.

The problem isn't that optometrists aren't capable of offering other services in a capitalist-competitive sense, it's that licensing regulations are preventing those services from existing.

If the congress wasn't so busy in some damn pissing contest over payments in the health care system, they might try to enact more structural improvements, like massive licensing deregulation.

[walterbell]

Do you have some examples of proposed OD practices blocked by MDs?

[asddkk]

It depends on the state, but what I've read of so far is mostly expanding the range of eye diseases that can be treated with medication, and expanding their prescription privileges. Some of it focuses on lasik surgery, which probably merits more scrutiny, but certain states already allow it.

E.g.,

http://www.sacbee.com/opinion/op-ed/soapbox/article75185362.... https://www.reviewofoptometry.com/article/new-york-ods-push-...

Here's examples of discussion from the physician side, which tends to be a bit more FUD-focused, and to be biased in how certain topics are approached:

http://journalofethics.ama-assn.org/2010/12/pfor1-1012.html https://jamanetwork.com/journals/jamaophthalmology/fullartic...

One of the articles starts by discussing psychologists, where similar issues arise. The typical AMA/physician group argument goes like this:

Profession X has specialized training in area A but limited to that, and not in area A+B. Physicians, in contrast, have training across a wide scope including B, and then in addition specialize in A.

The problem with this argument is that it presupposes that the only way to obtain training is by going from B, and then adding A, and ignores the argument that one could go from starting with A and then adding B. Optometrists aren't saying "everyone should be able to do lasik, or prescribe everything without training," they're saying "we are qualified to learn how to do it." Psychologists aren't saying "everyone with a license should prescribe," they're saying "people who have a license and then get additional training can prescribe."

The other problem is the physician groups tend to vastly undercharacterize the amount of training that often accompanies e.g., psychologists or optometrists. A psychologist was recent interim head of the National Institute of Mental Health, and many of them do research in psychophysiology, interventional and observational brain imaging, pharmacology, and so forth, and enter with the bio backgrounds. Conversely, the amount of actual coursework in medical school is increasingly less and less, and because they are covering so many areas of medicine, the amount of training they get across areas is relatively small.

My point isn't to belittle MD training, it's just to say that people have to be careful in the assumption that going from broader -> specific is necessarily better than going from specific -> broad, or that you have to start with certain education and then specialize, as opposed to picking up additional education along the way.

The issue is really a monopoly of (a) specific educational and training model(s) in the health care setting. Licensing is not actually competency-based, it's credential-based.