Commentary
The Eye Is Part of the Body
We must be careful not to lose our ties to medicine in general as we become more specialized.
By Gary S. Schwartz, M.D.
When I lecture medical students and primary care physicians, I often tell them to remember that the eye is part of the body. I say this because students and primary care providers too often see ophthalmology as such a specialized field that they don’t spend a lot of time studying it. Unfortunately, we ophthalmologists perpetuate this division by devoting so much of our time and energy to treating the eye that we fail to stay current in other areas of medicine, including those that consumed our lives during our medical school and internship years.
It is likely that other specialists feel similarly. As technological advances allow us to treat an increasing number of diseases, physicians have had to subspecialize to maintain an appropriate level of expertise in their field. Yet the more we hone our narrow niches, the less we may feel we have in common with our colleagues in other specialties, or even within our own specialty. In ophthalmology, for example, the practice realities faced by a retina specialist may overlap very little with those of a cataract surgeon or pediatric ophthalmologist. And they overlap even less with those of an obstetrician, internist, or orthopedic surgeon.
As individual practitioners insulate themselves from those with different practice focuses, myriad organizations have been created to support specialists of every type. The American Academy of Otolaryngology and Ophthalmology, established in 1896, was the first of the specialty societies. In 1979, it split into the American Academy of Ophthalmology (AAO) and the American Academy of Otolaryngology. The American Board of Ophthalmology, created in 1916, was the first specialty board. Today, about 93 percent of ophthalmologists in the United States are members of the AAO, yet only 37 percent of us are members of the American Medical Association (AMA). I would wager that a similar breakdown could be found in many other specialties.
In addition, disproportionately few ophthalmologists are active in their local and state medical societies. Although the Minnesota Academy of Ophthalmology is widely regarded as one of the most organized and active of Minnesota’s medical specialty societies, few of its members are involved in the Minnesota Medical Association (MMA). It may be surprising to know that no ophthalmologist currently practicing in Minnesota has served on the board of the MMA.
Specialization in medicine has benefited patients more than it has benefited medicine in general. Although the individual practices of different specialists may vary considerably, it is important to remember that there are similarities in the work that all physicians do. We must remember that at its most fundamental, the delivery of medical care is founded on the one-to-one relationship between the patient and the physician, regardless of specialty. In addition, we all contend with the challenges posed by third-party payers, reimbursement, practice overhead, government mandates, and so on.
The AMA and MMA are our best hope for addressing issues that affect the entire house of medicine. It would be shortsighted to assume that our specialty societies can influence the critical decision-making regarding these broader concerns as well as the AMA and MMA. It is not the mission of specialty societies to fight for all of medicine; rather, they exist primarily to support the specific needs of their members.
Ophthalmologists as well as primary care physicians need to remember that the eye is part of the body. Similarly, each specialist needs to remember that whatever organ system he or she may have dedicated a career to treating is part of the body, too. And all physicians need to remember that their specialty, no matter how specific, is part of the larger house of medicine. MM
Gary Schwartz is an ophthalmologist with Associated Eye Care. He has served as president of the Minnesota Academy of Ophthalmology and as a member of the American Academy of Ophthalmology’s board of trustees.
This article is based on an article published in the American Academy of Ophthalmology’s publication EyeNet in 2006.