Why doctors of optometry should seek hospital privileges

In the new world of bundled payments and medical models, doctors of optometry are increasingly part of interdisciplinary teams of providers—often working within the walls of a hospital or medical center.

Still, not many cross the boundary onto the hospital floor. For doctors of optometry to provide care at an inpatient's bedside, they must first be given hospital privileges.

The AOA recently released an update of its Optometric Hospital Privileges Manual, available to members for download. The manual explains both the benefits and logistics of hospital privileges for doctors of optometry, provides up-to-date information on how to make hospital privileges benefit doctors and their patients, and provides tips for doctors on how to flourish in a hospital environment.

Advancing the medical model

Stephen Lewis, O.D., has been practicing in the Shreveport, Louisiana, area for 30 years. During most of that time, he's had privileges with a local hospital.

Dr. Lewis sees everything from acute vision loss, double vision and complications of diabetes, to run-of-the-mill infections such as conjunctivitis. He works closely with local internists and is on call periodically overnight.

He thrives in the environment, he says. And he works closely with the hospital's ophthalmologist, who helped him gain privileges.

That's not common. Many ophthalmologists will fight doctors of optometry gaining privileges. That's part of why Dr. Lewis says he wanted to work on the AOA's manual—because, in his experience, being an optometrist associated with a hospital is a "huge feather in the cap of the hospital."

Working to scope of practice

Curt Baxstrom, O.D., like Dr. Lewis, has had hospital privileges for most of his 31-year career. He's not doing refractions in the hospital, though. He specializes in rehabilitation—a small but growing field for doctors of optometry.

He got involved in the revision of the hospital privileges manual because he wanted to ensure doctors are able to provide the most appropriate optometric services to inpatients, based on their training.

"Sometimes, they will want to narrow optometrists down to doing refractions on patients, so that they simply prescribe glasses," says Dr. Baxstrom, who is based in the Seattle area. "So I said, 'Ask for privileges that allow one to provide optometric services based on the licensure in the state of Washington.' That way, anything I can do in my private office, I can also do in the hospital."

Focusing on the win-win-win

It's often easier for doctors of optometry to gain hospital privileges in rural areas where there may not even be an ophthalmologist on staff, says James Sandefur, O.D., executive director of the Optometric Association of Louisiana, and one of the AOA members who worked on the revision of the manual.

It's a golden opportunity for doctors of optometry to practice in a way that lifts up the whole profession, while assisting everyone in the community.

It's more than a win-win, he says. It's a win-win-win.

"The hospital gets the income revenue from having an optometrist doing optometry procedures," he says. "And doctors of optometry benefit by being in the hospital environment with other physicians and patients. And patients benefit by having the procedures done at home and not having to go to an urban area to have their work done."