Opinion: Eye care needs to be delivered appropriately

Recently, an op-ed written by two of my colleagues in the New Hampshire House of Representatives encourages a positive vote on HB349, which would expand the scope of practice of optometrists and them to perform procedures hitherto restricted to M.D. or D.O. ophthalmologists. 

I come from a family with numbers of medical people. I am entering my sixth year chairing the Department of Health and Human Services Oversight Committee. Both family ties and legislative work keep me in regular contact with both medical people and with the medical needs of our citizens.

Years ago, my aunt Janet was a member of one of the first classes of training to be nurse practitioners. She had had many years of practice with a family medicine physician but didn’t have the time to get an M.D. or D.O. degree and go through a residency, both requisite to become a physician. But now, a new intermediary step was established.

She regularly told me two things, especially when I became a legislator:

First, “Make sure you work toward establishing various legitimate intermediary steps on the medical ladder.” But second, “Do not allow people to go outside their appropriate scope of practice.” She knew there would be nurse practitioners who thought too highly of who they were and what they could do medically.

Concern has been expressed that certain eye procedures were not available in various areas of the state, necessitating some travel. I recall some years ago a study indicating there were various medical “deserts” in New Hampshire, that is to say, places where various medical services were in short supply. 

Such a desert was identified in the North Country for advanced eye care among other needs, but here’s the update.

Androscoggin Valley Hospital in Berlin has now partnered with North Country Ophthalmology to provide advanced eye care treatment for residents. Other ophthalmologic eye care practices are similarly identifying remaining advanced eye care deserts and work to site ophthalmologists in them is under way.

A recent survey of over 1,400 New Hampshire residents demonstrated that people understand what’s at stake. When asked which was more important, expertise or convenient location, 88% of respondents said having procedures done by physicians was more important than proximity.

In the North Country, that forced choice is now gone. One can have advanced level eye care and have it nearby.

That recent column speaks of optometrists “who earn doctorate degrees.”

While that is technically true, it isn’t the whole truth.

When people hear the word “doctor” they think “physician,” someone with a four-year undergraduate degree, four years of medical school, and several years of post-doctoral residency. 

I have an earned doctorate, but when someone calls thinking they’re speaking to the physician Doctor Pearson I am quick to say no, you want my wife. Yes, I am Dr. Pearson but I am not the medical Doctor Pearson.

Very simply, optometrists may have an O.D. degree and are doctors of optometry, but they are not physicians. When medical complications arise — and ample research indicates they do — you want and need a physician, not a technician, however good they are in their current scope of practice.

That recent survey of New Hampshire residents demonstrated that people understand the risk. Seventy-six percent of New Hampshire people oppose allowing non-medical doctors to perform eye surgery. Only 8% support it. Even the majority of political Libertarians agree.

I appreciate the wonderful work optometrists do. Our effort should be to assist in siting highly qualified people in those medical care deserts we have, not inappropriately expanding optometrists’ scope of practice.

Rep. Mark Pearson is entering his tenth year in the House. He serves Rockingham County District 34, Hampstead, Kingston and East Kingston. He has a Masters from Oxford University and a Doctorate from Boston University (but not in medicine).