As we consider our careers in optometry after graduation, one modality of practice that often gets overlooked is that within hospitals. The 2006 AOA scope of practice survey showed that 11% of ODs have hospital privileges. The question becomes what can you as the optometrist do in a hospital setting? There are various roles for optometrists in hospital environments that include emergency care in the ER, routine eye care in the OPD, medical eye care, and specialty services like low vision and rehabilitation care.
It appears that most hospital ERs are not suited to provide ocular care. This presents a unique opportunity for us to engage our community hospitals and indicate the extent to which we can provide care, and potentially try to get appointed as a consultant/employee.
There are many advantages of working and being associated with a hospital. Some of these include being able to co-manage medical and surgical patients, having the ability to order different types of diagnostic tests, and affiliation will likely lead to more referrals and great networking opportunities.
So the question becomes what has impeded optometry’s involvement in the hospital setting? There used to be bylaws that limited hospital affiliations with only medical or dental personnel; therefore, ODs could not get any privileges within a hospital setting. NY State was first state to pass a law that said hospitals could not discriminate against ODs, and eventually the laws were subsequently changed to allow optometrists to be affiliated with hospitals thus adding to the type of practice modalities available to optometrists.
Some interesting statistics showed that of hospitals that had eye care services, 43% had an OD and 56% only had an ophthalmologist. It also appears that optometry’s involvement in hospitals depends on the type of hospital. For example, studies show that almost all governmental hospitals and most city run hospitals have an optometrists on staff. Larger hospitals were more likely to have ODs than small, and proprietary hospitals were less likely to have optometrists than non-profit.
It is important to remember that there is a particular organizational structure whereby eye care is being delivered and how optometry fits into that. About half of all hospitals with ODs were in the department of ophthalmology. There were very few percentage of ODs in surgery, and very few with their own department. The problem with this is that, when you are working within another department and not your own distinct department, your autonomy is confined. This is an area where we as optometrists need to work on. While we can be affiliated with hospitals and work in the aforementioned settings, we should also pay close attention to small community hospitals that do not have ophthalmologists working there. We should utilize these communities to make an effort to establish ourselves as providers in these hospitals that lack eyecare services.