The Legislature can act this session to provide people across Washington with better access to high-quality, affordable eye care. Doing so won’t cost anything; it will actually save money.
Access to health care is a serious problem, and eye care is an area of growing concern. Wait times to see an ophthalmologist can be three months or more. The patients most impacted are more likely to be older, low income, minorities and rural residents.
Lawmakers could help improve this problem by updating the approved scope of practice for Washington optometrists, allowing them to perform a range of minor procedures, deliver injections around the eye, and prescribe certain oral medications – all of which are part of their education and training.
Optometrists complete four years of specialized post-graduate training on the anatomy, pathology and treatment of the eye. Many add a residency, board certification or other specialized training, and all must comply with strict continuing-education requirements to maintain their licenses. These well-trained medical professionals serve as primary eye care providers for most individuals.
Unfortunately, optometry’s scope of practice in Washington has not been updated since 2003, before the original iPhone was introduced. Think about how your use of technology has changed since then. The same is true in optometry: Advances in procedures, technologies, medications and education all have improved how eye doctors provide care for their patients.
But Washington’s regulatory structure hasn’t kept up, which prevents optometrists from practicing to the full extent of their education and training. For example, Washington is one of only eight states that prohibit some oral medications used to treat inflammatory diseases in and around the eye.
Bringing Washington’s rules up to date would improve access to care. There are approximately three times as many licensed and practicing optometrists in Washington as there are ophthalmologists. Optometrists currently practice in 92% of Washington counties, while residents in nearly 40% of Washington counties, primarily in rural areas, have no local ophthalmologists.
This is especially important for Eastern Washington’s rural communities. When optometrists are forced to refer patients to another provider for treatments they are trained to perform but prohibited from providing, the drive to the nearest available caregiver can be two to three hours.
This waste of time is just one way outdated scope of practice laws harm patients. Take, for instance, the additional costs a patient incurs for a procedure as simple as removing a benign lesion on the eyelid. If the optometrist was allowed to perform the procedure, it generally could be diagnosed and treated in the office right then. One visit, one insurance co-pay.
But when that patient must be referred to an ophthalmologist, there can be a serious delay in receiving treatment. They’ll face at least one additional appointment and a second co-pay. As often as not, there could be a diagnostic appointment in the provider’s office followed by the procedure appointment at an ambulatory surgery clinic. These clinics charge a facility fee on top of the provider’s fee, roughly doubling the total cost.
In addition to these direct costs, there are other indirect but very real expenses: additional travel expense, day care, and more time off work – not just for the patient but also for a companion to accompany a patient whose vision is temporarily compromised.
Considering the inconvenience of getting a referral appointment and the increased costs involved, many patients will put off getting the care they need – or not follow through at all. These unfortunate decisions can put their vision – or more – at risk.
Oregon and Idaho authorize the treatments that Washington optometrists are proposing be added to their scope of practice. A Spokane optometrist holding dual licensure and also practicing in Coeur d’Alene can perform those procedures there, but not here. Crossing the border back into Washington doesn’t make that optometrist any less trained, experienced, or skilled.
After reviewing draft legislation to increase optometry’s scope, the Department of Health has concluded that additional procedures can be safely added to optometry’s scope of practice.
Lawmakers should take these findings seriously and update optometry’s scope of practice.
Dr. Grant Hardan is a Spokane optometrist.
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