Practice Tips4EyeDocs – Diabetic Report Form to a Primary Care Provider

Practice Tips4EyeDocs – Diabetic Report Form

For most doctors who see patients with chronic illnesses, the customary report letter like a diabetic report form is often a quandary. Whether new or even established, the question is often asked “What is enough? What is too much?”

When I last practiced, I used the above form as a handout and as a report form to the patient’s primary care provider. It’s simple and to the point. Of course, as I look at it now, I could make some adjustments. If you like this form, kindly email me by sending your comment to this blog. I will be glad to provide you with your own form (retaining of course my copyright).

Disclaimer: These are the personal opinions of Dr. Hom and not medical, legal or financial advice. It is designed for entertainment or education. He is also a licensed life, health and disability agent in California, License # 0I18299.

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“CareerChange4ODs” Tips – How come it takes so long to get hired?

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The Long Interview Process Infographic by Nerdgraph

Across the country, the interview process has lengthened significantly. Part of the reason this has occurred in the last 10 years is the economy. The other reason is the legislated and mandated regulations and costs that accompany each new hire. For many companies, small and large, these factors are significant.

In this current milieu, the “CareerChange4ODs” applicant must prepare for a whole new interview process, one that has evolved most often after the majority of optometry graduates had sought jobs. For the “CareerChange4ODs” applicant, changing industries or vertical markets means that professional and clinical positions differ significantly from those in vertical market or industry. The outcome is a lengthy interview process that may involve an initial phone screen by the hiring manager and several stages of interviews with other team members. Here are three tips to keep you engaged and focused during this process.

First, consider everyone that you meet in any interview whether it is Human Resources (HR) or the receptionist are “interviewing” you. Continue that approach with every person you encounter in that company.

Second, passion and teamwork are the two most significant attributes that new employees will need to “fit in” with the team and to show that the outcome or result is a primary focus. Because most resumes cannot easily differentiate between this doctor and that one, it falls to the face-to-face interview as being the decisive process. It’s the one that your interviewers can see your passion. Show it.

Lastly, Be patient. The process may take up to 4 or more instances and up to six months. Don’t be discouraged because I have seen jobs that have been removed from a site not because it was filled. Simply put, some hiring managers may change the strategic or tactical rationale for a position and will withdraw it and then repost it.

In summary, the new “CareerChange4ODs” can look forward to an interview process that mayi stretch into months and involve many levels of interviewers. Don’t despair. It’s like a marathon, it requires training and patience.

For further reading

Devi, S. (2013, May 8). The hiring process goes on…and on… Financial Times. Retrieved May 10, 2013, from http://www.ft.com/cms/s/0/05cc12f4-a68d-11e2-885b-00144feabdc0.html#axzz2SuYpLFlE
John, W. (2011, October 3). Why is the Interview Process So Long? – Electrical News. Electrical News. Retrieved from http://www.electricalnews.com/why-is-the-interview-process-so-long/
Rampell, C. (2013, March 6). With Positions to Fill, Employers Wait for Perfection. The New York Times. Retrieved from http://www.nytimes.com/2013/03/07/business/economy/despite-job-vacancies-employers-shy-away-from-hiring.html
The evolution of the interview process. (2013, May 9). Nerdgraph.com. Retrieved May 9, 2013, from http://www.nerdgraph.com/the-evolution-of-the-interview-process/
Wendell, M. (2011, July 4). Why does the hiring process take so long? Molly’s Blog. Retrieved from http://mollywendell.wordpress.com/2011/07/04/why-does-the-hiring-process-take-so-long/

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Unoprostone – A new player in glaucoma therapy

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Unoprostone (Rescula)

A relatively new player has reached the topical glaucoma medication market, unoprostone. What makes this a true alternative are its properties of decreased redness upon application, less pigmentation of the periorbital skin and
increased optic nerve head blood flow.

Traditional anti-glaucoma medications may have one or two properties, but none have all three. For example Betoptic S, 0.3% has a mild effect on intraocular pressure (IOP) and a limited effect on neuroprotection. Practically, all the customary topical prostaglandin analogs have equal effect on IOP, but retain the side effects of hyperemic eyes and darkening of the periorbital skin. Brimonidine has gone through several iterations and its newest, formulation of 0.1% has less redness but its effect on IOP isn’t as much as a prostaglandin.

A distinct disadvantage for unoprostone exists, mainly its dosage. It is a twice daily medication whereas its companion prostaglandins are once daily. The dosage may not be a significant obstacle, though, if unoprostone can deliver on its claim of less redness, less periorbital skin color change and better optic nerve head health.

Of course, one of the banes of glaucoma therapy is the large numbers of patients who disliked the redness, one of the most obvious side effects of any prostaglandin and one that I feel has driven patients away from being either compliant or asking for another medication alternative.

In summary, the studies show that its IOP effect is as good as any other prostaglandin and it should be a viable course of action as a primary monotherapeutic agent. Alternatively, unoprostone might also be a good second choice prostaglandin where the primary choice has significant patient concerns For the first time, a change within the prostaglandin class is possible without loss of effiacy.

For further reading:

Chen, C.-L., Tseng, H.-Y., & Wu, K.-Y. (2006). Rescula as an alternative therapy for beta-blockers with long-term drift effect in glaucoma patients. The Kaohsiung journal of medical sciences, 22(6), 266–270. doi:10.1016/S1607-551X(09)70310-9
Harms, N. V., & Toris, C. B. (2013). Current status of unoprostone for the management of glaucoma and the future of its use in the treatment of retinal disease. Expert opinion on pharmacotherapy, 14(1), 105–113. doi:10.1517/14656566.2013.748038
Inoue, K., Shiokawa, M., Higa, R., Sugahara, M., Soga, T., Wakakura, M., & Tomita, G. (2012). Adverse periocular reactions to five types of prostaglandin analogs. Eye (London, England), 26(11), 1465–1472. doi:10.1038/eye.2012.195
Mukuno, H., Nakamura, M., Kanamori, A., Nagai, A., Negi, A., & Seigel, G. (2004). Unoprostone isopropyl rescues retinal progenitor cells from apoptosis in vitro. Current eye research, 29(6), 457–464. doi:10.1080/02713680490889465
Ohashi, M., Mayama, C., Ishii, K., & Araie, M. (2007). Effects of topical travoprost and unoprostone on optic nerve head circulation in normal rabbits. Current eye research, 32(9), 743–749. doi:10.1080/02713680701531090
Saito, Y., Saeki, T., & Sugiyama, K. (2006). [Long-term effects of isopropyl unoprostone monotherapy on intraocular pressure and visual field for normal-tension glaucoma and primary open-angle glaucoma patients]. Nippon Ganka Gakkai zasshi, 110(9), 717–722.

Disclaimer: These are the personal opinions of Dr. Hom and not medical advice and is solely for entertainment or educational purposes. He is also a licensed life, health and disability agent in California, License # 0I18299.

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What’s up with involvement and volunteerism in optometry?

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Voluntary non-profit professional membership organizations face a growing problem that they never envisioned ten or even twenty years ago; membership and engagement have been falling steadily. Theories from past scholars (Gruen, 2000; Lawrence, 2004; and Petrof, 1998) indicate that professional membership organizations are difficult to study. In our own optometric profession, the American Optometric Association and its companion affiliated state associations have battled internecine warfare over a variety of issues. Whether from controversial issues or the general economic conditions, it is unarguable that the profession perceives that its professional organizations are facing stagnant or even falling

I wrote this blog post after I attended a dance competition where I overheard a conversation. It appears that ”older” dance club members did not attend the younger members’s performance to cheer them on. Yet, the younger members did go to the older club members’ performances. The younger girls theorized and lamented the lack of commitment of the older members.

Do professional organizations behave like this dance club? In the case of the dance club, the younger members still are striving to achieve an objective where the older members are winding down their own dance careers (none apparently were seeking collegiate or professional careers as dancers). Is the optometric profession seeing a parallel pattern? I don’t know, but if younger members are still seeking their goals and the older members have achieved theirs, can a generational divide occur. It’s possible.

Alternatively, do younger members form and maintain personal and organizational relationships easier than older ones? In the studies cited at the end of this blog post, the pressures to remain a member of a professional organization are mixed. There is a suggestion that a member needs to see a tangible benefit and want the organization to market to them. Another suggests that professions that seek self-identity are more prone to weak relationships with an organization. And finally one author suggests that allegiance to a single organization rather than a choice of more than one causes confusion and inner conflict thus negating the perceived benefit of either.

Whatever the reason or cause of stagnant or falling membership, this portends poorly for a professional organizations that depend upon volunteerism to man its committees and administrative posts. It relies on the members to supplement or complement its legislative advocacy. Without these volunteers, the effectiveness of any professional organization is hampered.

In summary, the profession of optometry is faced with an overall fall of volunteerism which parallels and sense of apathy and even avoidance of their professional organizations. There are no easy answers, but one thing is sure, a fracture between the professions, no matter what the perceived benefit of either, is a sign of falling volunteerism. The result is unthinkable.

For further reading:

Gruen, T. W., Summers, J. O., & Acito, F. (2000). Relationship marketing activities, commitment, and membership behaviors in professional associations.The Journal of Marketing, 34-49.

Lawrence, T. B. (2004). Rituals and resistance: Membership dynamics in professional fields. Human Relations, 57(2), 115-143. Retrieved from http://search.proquest.com/docview/231492110?accountid=35812

Petrof, J. V. (1998, March). Relationship marketing–the emperor in used clothes. Business Horizons. p. 79.

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#CareerSunday: Top 5 Obsolete Optometry Skills – CareerChange4ODs

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For the “CareerChange4ODs” tip on this Sunday’s blog post, I was stimulated by two posts (Hall, 2013 and Hardaway 2008) that showcased obsolete skills. I wondered whether optometry has a similar list of obsolete skills.

Doctors attending CE to keep their skills up, a CareerChange4ODs tip

In optometry, unlike a non-medical career field, doctors are compelled by state license boards to attend a certain amount of continuing education hours. These courses encourage doctors to maintain currency in the field. Yet for the “CareerChange4ODs” doctor, transferring their 20 or even 30 year work history into a new clinical optometry position may troublesome. Certainly the new employer will watch for obsolete skills on a resume that signal a lack of currency.

Here is my top 5 list:

Tangent field – While a useful test in its time, the tangent field has been overshadowed by the automated visual field. I suppose if I did not have one of these field testers, I could use a tangent screen. But the newer field machines can be more repeatable and more sensitive than a tangent field.
Schiotz tonometry – With the advent of handheld applanation and pnetonomatic tonometers, a skill at Schiotz instrument is certainly anachronistic.
Polishing and modifying rigid contact lenses – While there may still be PMMA and low Dk rigid lens wearers, for the most part, there are scant opportunities to practice this skill. In fact, I find few offices still using modifying kits consistently.
Film retinal or fundus photography – in less than five years, digital retinal photography has swept the market place. The instant availability of the final image reduced patient anxiety annd photographer training. Digital acquisition also reduced the need for large storage cabinets to hold images.
Manual Keratometer – With today’s “3-in-1″ automatic keratometer and corneal topography mapping devices, the utility of the manual keratometer is quickly slipping into obsolescence. In many offices, it sits on an instrument stand’s arm but is usually tucked away into the corner where it collects dust.

In summary, the “CareerChange4ODs” doctor can change their practice through the acquisition of new skills and knowledge by attending continuing education courses and practicing these skills. With the large number of available optometrists, staying employable will be a constant requirement.

For further reading:

Hall, B. (2013, May 1). 10 Technology Skills That Will No Longer Help You Get A Job. ReadWrite. Retrieved May 4, 2013, from http://readwrite.com/2013/05/01/10-technology-skills-no-longer-in-demand
Hardaway, F. (2008, February 16). Obsolete skills. Scobleizer. Retrieved May 4, 2013, from http://scobleizer.com/2008/02/16/obsolete-skills/

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Deegan Lew OD FAAO – A Passing So Early, So Sudden

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Deegan Lew OD FAAO

This morning, 02 MAY 2013, I read on Optcomlist that a friend and a colleague, Deegan Lew OD FAAO, had died suddenly while doing what he liked most, exercising and working out. I had watched and followed Dr. Lew’s life through his Facebook Page and last saw a photo of him while sleeping on a couch, adorn in his athletic attire.

Dr. Lew, most recently of the University of Colorado at Denver Medical School and Department of Ophthalmology was a kind, gentle and generous person. He was the ultimate professional. I first met him six years ago and have followed his career since them. He generously shared his wisdom and knowledge on Optcomlist, Facebook, and other eye care venues. His words of wisdom and encouragement refreshed my career.

Thank you Dr. Lew for your past thoughts on optometry and the profession. Thank you for gracing us with your presence. Thank you for your love of your patients and your diligence in giving the best care you can. I miss you and I think the profession will miss you.

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Is optometry ready for bundled care / payment?

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In late 2011, the U.S Center for Medicare and Medicaid Innovation has launched a concept called “bundled care” for acute and hospital care. It is isn’t too farfetched that bundled care in that arena might creep into the vision care space. An instrument, accountable care organizations (ACO) is positioned as an instrument to promote bundled care/payment. Is optometry ready for such a movement?

Briefly, the concept is to reward or pay for a range of services for a particular patient for a particular outcome. These services have to be coordinated in some fashion and the medical home under the ACO model is the likely source of that collaboration. In this way, the primary care physician remains as either the “quarterback” or the case manager for care for a particular patient.

A slowly ominous outcome for optometry is its inability of to take part in any kind ACO or bundled care/payment initiative. That’s because the medical home is a wholly medical concept that is driven by primary care medicine. A problem exists for optometry. The profession has led a charmed life as a legislated profession and as such legislation or regulation is necessary to compel optometry inclusion in any kind of scheme for bundled care/payment.

Optometry seems silent around participation in bundled care/payment. Generally, optometry hasn’t publicized quite yet the need for its inclusion in ACOs and bundled care/payment. Watching the various optometry blogs, readers are frustrated by a general lack of understanding of how optometry can participate in these new US Center for Medicare and Medicaid Innovations (CMS). Either the readers are looking for a source of authority in the profession to lead optometry into participation or they are looking to its organized leadership to do so. But distrust prevails within the profession as an onerous internecine struggle within the profession has distracted many from staking a place for optometry.

Assuredly, even though that pace may be slow, the rush to position optometry as a key player in eye care and in primary care is based upon a longstanding heritage that the eyes are critical sign posts for systemic medical problems and that loss of sight brings significant social and rehabilitative costs that are preventable if there is early detection and management. It makes sense for optometry to participate in bundled care/payment.

In summary, there are visible milestones that CMS is serious about controlling health care. This means that the traditional “fee-for-service” model may be anachronistic and that a bundled care/payment is its successor. Where will optometry play?

For further reading:

ACO – Bundled Payment. (n.d.). Wedi. Retrieved April 21, 2013, from https://www.wedi.org/workgroups/aco-bundled-payment

Ahlquist, M. J., Saxena, S. B., & Spencer, B. (2013, January 30). Bundled Care: The Voice of the Consumer. Booz & Co. Retrieved April 21, 2013, from http://www.booz.com/global/home/what-we-think/reports-white-papers/article-display/bundled-care-voice-consumer

Bouchard, S. (2013, April 17). Poll finds consumers like bundled care. HealthCare Payer News. Retrieved from http://www.healthcarepayernews.com/content/poll-finds-consumers-bundled-care

Bundled Payments for Care Improvement (BPCI) Initiative: General Information | Center for Medicare & Medicaid Innovation. (n.d.). Retrieved April 21, 2013, from http://innovation.cms.gov/initiatives/bundled-payments/index.html

Bundling Payments to Curb Health Care Costs Proves Difficult to Realize | RAND. (2011, November 7). Retrieved April 21, 2013, from http://www.rand.org/news/press/2011/11/07.html

Latest accountable care act initiative: Bundled payments for care improvement. (2011, September 19). Retrieved April 21, 2013, from http://www.proskauer.com/publications/client-alert/latest-accountable-care-act-initiative-bundled-payments-for-care-improvement/

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All Things About Optometry & Technology

TIps4EyeDocs by @GrandRounds4ODs

Practice Tips4EyeDocs – Diabetic Report Form to a Primary Care Provider

“CareerChange4ODs” Tips – How come it takes so long to get hired?

Unoprostone – A new player in glaucoma therapy

What’s up with involvement and volunteerism in optometry?

#CareerSunday: Top 5 Obsolete Optometry Skills – CareerChange4ODs

Deegan Lew OD FAAO – A Passing So Early, So Sudden

Is optometry ready for bundled care / payment?

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