Which type of eye doctor do you need? Optometrists and ophthalmologists face off

Ophthalmologists are medical doctors who specialize in treating the eyes. Optometrists have less training and specialized education, but now provide most primary eye care in the United States, routinely diagnosing and treating conditions that were outside their scope of practice half a century ago. (FG Trade/Getty Images)

This past November, a patient asked optometrist Kaitlin Soracco to remove a bulge of skin on her eyelid. Such skin tags can be excised right there in the office using procedures Soracco studied and observed in optometry school almost a decade ago. Yet in California, where Soracco works, as well as in 32 other states, non-physician optometrists are not legally permitted to perform these treatments. So when Soracco saw this patient at Peach Tree Live Oak, a federally qualified health center north of Sacramento, she had to refer her to an ophthalmologist, a type of physician who specializes in treating the eyes.

But such referrals can be difficult. Some ophthalmologists have stopped accepting Medicaid, the low-income health insurance program that supports 30 percent of all Californians, said Peach Tree CEO Greg Stone. In California, Medicaid payments for some laser procedures run 16 to 55 percent lower than Medicare reimbursements, which are, in turn, well below commercial insurance fees. For ophthalmology practices already filled with commercially insured patients, Stone said, accepting someone new on Medicaid doesn't make sense financially. Consequently, for Medicaid patients, it can often take six months to be seen by a specialist, Soracco said.