Image copyright (c) Ontario Department of Public Services, Labour Image caption Opposition to health care reform is focused on the provincial optometrist
Analysis
Doctor shortages and demand have been the main drivers of a move by Ontario’s Conservative government to restrict the ability of optometrists to practise.
But there’s another factor at play – the long-running battle between optometrists and opticians.
Adversity won and optometrists are being forced to accept a cut in rates for their services. It’s not the first time optometrists have taken a win while opticians lost.
We now have a third party mediator going into some of the issues. It’s the third attempt in two years by the NDP to bring together doctors and optometrists to end what is sometimes called the “optometrist-optician war” over treatments and fees.
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Optometrists insist they should be allowed to fix glasses without using anaesthetic. The campaign has had a big impact.
Optometrists currently qualify to do so by completing an optometry course or registering with the optometrist board. The approval of individual optometrists is required by regulation.
The new fee plan, opposed by the opticians association, is to privatise optometry.
What is the state of eye care in Ontario?
Ontario has been bogged down in a dispute for years. The long-running battles have resulted in fees for treatments being negotiated between the opticians and optometrists. It’s not always that straightforward.
The opposition Progressive Conservatives have targeted optometry fees as one of its objectives of delivering significant changes to Ontario’s health care system.
Some argue that optometrists are required by law to operate as opticians. Other eye care providers say they are simply allowing a registered optometrist to take over services that are provided in a commercial context by opticians.
“Opinion is clear around the current decision-making process in Ontario that currently allows optometrists to practise as opticians,” said Deborah Brown, spokesperson for the Ontario Optometric Association (OOA).
The OOA insists its members have a responsibility to deal with vision challenges in a way that “has an impact on patients” and “serves the needs of the community”.
However, opponents see the optometrists as trying to usurp the role of opticians by offering full-time medical services. And they use optometry’s struggles with patients to accuse opticians of poor service.
Dr Penny Love, vice-president of the Opticians Association of Ontario (OAO), responded by saying the OOA uses the same misguided argument that optometrists are applying to opticians.
“Optometrists have the training, tools and resources available to provide top-notch service and they continue to provide it at above the national average for Ontario eye care,” she said.
Things have been so contentious that two mediators have been trying to broker peace between the parties. But the latest attempt in 2018 failed, with the OOA opting not to renew its agreement to join the OOA.
The government said that was because the OOA not being willing to negotiate on the fee arrangements for eye services.
“The OOA then doubled down on its refusal to help negotiate a fair agreement and failed to renew its contract agreement,” said the health minister, Helena Jaczek.
The OOA has threatened to pull its opticians from the provincial network, leaving all patients facing a possible shortage.
What’s the latest situation?
The OVO has done a partial retreat. Optometrists will be able to opt into the newly privatised system without an optometry course.
“Optometrists have a role to play in the new managed delivery system of primary eye care,” said Deborah Brown.
However, the OVO wants the government to provide opticians with a permanent funding stream to be able to bid for more private contracts in the new health system.
But the OLO says that the fees involved in the contracts would lower patients’ standard of care.
Ottawa-based law professor and optometrist Shai Akabas, who is affiliated with the University of Ottawa and the University of Toronto, thinks patients should be protected.
He said there was significant evidence to back that up.
“It makes little sense to put a machine in front of patients that they cannot even look at without anaesthetic. Having such a machine is quite like having a machine in front of a surgeon that they cannot actually examine with their bare eyes.”
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