The 39,000 Question?

[Paul Farkas]

CEwire2015 by all measure for a first attempt was a success. Having 1300 register and eventually take over 30 hours of COPE approved CE is gratifying.

However, that represents a minuscule number of ODs who require C/E for re-licensure. How about the 39,000 of you who did not register? Where did ODwire.org fail?

Did the message go out and received by all ODs? If not how do we reach these folks?

Were the courses varied enough to allow choice for ODs tired of same old, same old C/E. What courses and speakers should be added if there is a CEwire2016?

We appreciated the vendors who supported our first attempt without knowing if there even be an audience. I think vendors were pleased by our support to make ODs aware of their booths. I hope registrants attending live, visited the booths asked questions and took advantage of the discounts scheduled to expire on 5/31/15.

Now the challenge...how to attract the deep pocket vendor big boys, who spend over six figures at live C/E events to show their support. this would allow hefty contributions to our designated charities. Some won't advertise on ODwire.org because of our policy of allowing vendor criticism. CEwire.org is different and free of debate. Time for Corporates to "belly up to the bar" and show support.

For those who have not as yet signed up for CEwire2015, please share why. For sure the under $5 per credit hour without the need to travel is inexpensive as you will find for C/E.

What can we do to attract you 39,000 for the next three months of CEwire2015 and then CEwire2016?

 

[Greg Gemoules]

CEwire2015 by all measure for a first attempt was a success. Having 1300 register and eventually take over 30 hours of COPE approved CE is gratifying.

However, that represents a minuscule number of ODs who require C/E for re-licensure. How about the 39,000 of you who did not register? Where did ODwire.org fail?

Did the message go out and received by all ODs? If not how do we reach these folks?

Were the courses varied enough to allow choice for ODs tired of same old, same old C/E. What courses and speakers should be added if there is a CEwire2016.

We appreciated the vendors who supported our first attempt without knowing if there even be an audience. I think vendors were pleased by our support the response. I hope registrants attending live, visited the booths asked questions and took advantage of the discounts scheduled to expire on 5/31/15.

Now the challenge...how to attract the deep pocket vendor big boys, who spend over six figures at live C/E events to show their support, so we can give hefty contributions to our designated charities. Some won't advertise on ODwire.org because of our policy of allowing vendor criticism. CEwire.org is different and free of debate. Time for Corporates to "belly up to the bar" and show support.

For those who have not signed up for CEwire2015, please share why. For sure the under $5 per credit hour without the need to travel is inexpensive as you will find for C/E.

What can we do to attract you 39,000 for the nest three months of CEwire2015 and then CEwire2016?

I still like to go, see, touch and just get out of my armchair once in awhile. Personally my attention span has become shorter and I quickly get bored with online courses DESPITE the fact that I do spend too much time online (but then I am not ever in one place for too long). I should think that 1300 for the first outing is something to be extremely pleased with. It should be easy to grow that number provided those who attended liked the content.

Another possible angle is that I start thinking about online courses towards the end of the year especially if I am short a few hours. Maybe that will prove to be the sweet spot for ODWire.

 

[Steven Nelson]

I would hazard a guess that a large number of ODs wait until the very last minute to get their online CE hours because there's no time crunch. I'd bet that if you did another conference in December, you'd probably get a larger volume of folks.

 

[Joe DiGiorgio O.D.]

I signed up. I am just watching more videos today. You guys did a nice job.

One question I have for Admin Wolf: Is there any way to speed up the playback slightly (I do this on MS Media player). I love the content, but find the real time playback sedating. Actually I have tried putting on some Vivaldi music quietly in the background along with an espresso, and I am feeling more energized. Just asking

 

[Paul Farkas]

I would hazard a guess that a large number of ODs wait until the very last minute to get their online CE hours because there's no time crunch. I'd bet that if you did another conference in December, you'd probably get a larger volume of folks.

Interesting that ODs would wait for the last minute when anything can go wrong...family emergency...weather etc.

We have to study how many states expire in December or Mid year.

Down side are vendor budgets begin after the first of year. No vendors could be a problem.

 

[Richard Frankel]

I haven't had a chance to catch any of the seminars yet. I'll do it over the summer. However, as far as getting more exhibitors, you should have asked your lecturers to ask the companies that they deal with. In addition, the reps could have been used to spread the word about the seminars, as they met with ODs. Just as VisionWeb did an article on it in an email, a short plug could have been added to company invoices at the bottom of the pages.

As far as additional topics, Lloyd Pate could bring a lot to the table.

 

[Paul Farkas]

As far as additional topics, Lloyd Pate could bring a lot to the table.

We have our list ready such as Lloyd for those who are ready for CEwire2016. Our time frame was just too short for many speakers unless they had a prepared course.

Listeners have no idea how difficult it is to prepare an interesting well designed presentation and have it timed for 50 minutes. That is why speakers should be well compensated for their time.

Are you listening program chair people?

 

[AdminWolf]

I still like to go, see, touch and just get out of my armchair once in awhile. Personally my attention span has become shorter and I quickly get bored with online courses DESPITE the fact that I do spend too much time online (but then I am not ever in one place for too long). I should think that 1300 for the first outing is something to be extremely pleased with. It should be easy to grow that number provided those who attended liked the content.

Another possible angle is that I start thinking about online courses towards the end of the year especially if I am short a few hours. Maybe that will prove to be the sweet spot for ODWire.

The conference is still open, of course -- people have about 3 months to take the classes, so i'm hoping they take advantage over the summer as time permits.

 

[Joe DiGiorgio O.D.]

I just finished watching the OCT presentation by Mark Friedberg, MD. It was very good, and highly recommend that others watch it.

BTW--He has a great discussion about Plaquenil Toxicity starting at about 1:33.30

 

[Steven Nelson]

Interesting that ODs would wait for the last minute when anything can go wrong...family emergency...weather etc.

We have to study how many states expire in December or Mid year.

Down side are vendor budgets begin after the first of year. No vendors could be a problem.

I absolutely wouldn't do another one this year. Too expensive and that's the last habit you want someone to develop. All I meant was that it could have been earlier than many seek CE.

Maybe it might be interesting to evaluate any available metrics on when online CE is sought...but regardless, over 1300 giving good reviews is an amazing turnout and a testament to the support of this community.

 

[Steven Nelson]

I just finished watching the OCT presentation by Mark Friedberg, MD. It was very good, and highly recommend that others watch it.

BTW--He has a great discussion about Plaquenil Toxicity starting at about 1:33.30

I watched that one as well and it was well worth the time spent. I may actually watch it again. The beauty of online learning.

 

[Greg Gemoules]

Interesting that ODs would wait for the last minute when anything can go wrong...family emergency...weather etc.

We have to study how many states expire in December or Mid year.

Down side are vendor budgets begin after the first of year. No vendors could be a problem.

That actually did happen to me once, and I was about to see how many online courses I could find only to be told by the Texas Optometry board that not all of the requirements could be met online. But humor me for a moment. You don't actually believe that anything short of 39,000 attendees is a monumental failure?

 

[Edmundo C.Fimbres]

I just finished watching the OCT presentation by Mark Friedberg, MD. It was very good, and highly recommend that others watch it.

BTW--He has a great discussion about Plaquenil Toxicity starting at about 1:33.30

This was a great lecture.

 

[Richard Frankel]

That actually did happen to me once, and I was about to see how many online courses I could find only to be told by the Texas Optometry board that not all of the requirements could be met online. But humor me for a moment. You don't actually believe that anything short of 39,000 attendees is a monumental failure?[/QUOTE

 

[Richard Frankel]

On the contrary, this was a monumental success! It's not just the 1300+ people who enrolled:
1. The concept was shown to be viable. Everyone talked about it, but no one has done it previously.
2. The infrastructure is now in place for future use.
3. The idea of being at the mercy of profit driven organizations is fast coming to an end.
4. Corporation can present new products and ideas at a fraction of the cost. What was needed, was "operators standing by" for instantaneous feedback to doctors. Thst can be remedied in the future.
5. We now have a platform to provide uniform educational programs nationwide on topics of immediate and important issues . For example, a series of programs updating general Medical knowledge on diabetes, such as diagnosising and treating. Other Medical topics could follow.
6. The concept of the power of the Internet was validated. This was further recognition of a shift in institutional influence.

 

[AdminWolf]

This was a great lecture.

I will confess I was nervous about having an OMD as part of the conference -- I was concerned by how everyone would respond. Friedberg is a great lecturer though (... and has what Paul might call the "Prestige Factor", being associated with Wills.)

Going forward, would you like to see more folks like him participate?

thanks
ad

 

[Richard Frankel]

I will confess I was nervous about having an OMD as part of the conference -- I was concerned by how everyone would respond. Friedberg is a great lecturer though (... and has what Paul might call the "Prestige Factor", being associated with Wills.)

Going forward, would you like to see more folks like him participate?

thanks
ad

I'm interested in the best lecturers who I can learn from. There were a number of OMDs in New Jersey, who testified on our behalf for TPA at the time . Blanket hatred or discrimination serves no one.

 

[Steve Silberberg]

And adding to Rich not only is Mark Friedberg a great lecturer but Optometric Friendly. He is my go to Retinal guy only 15 miles away and patients love him. he is always supportive of Optometry. I comanage many difficult cases with him rather than him just taking over the total care after an RD , Lucentis treatment etc. I have heard him lecture many times and he never disappoints. He told me after the conference how impressed he was with the platform and the depth of education. By coincidence he delivered the very same lecture the Monday after live and you missed nothing by doing it online. I recused myself from answering his questions of course not wanting to be a gunner with all the answers

 

[Richard Frankel]

And adding to Rich not only is Mark Friedberg a great lecturer but Optometric Friendly. He is my go to Retinal guy only 15 miles away and patients love him. he is always supportive of Optometry. I comanage many difficult cases with him rather than him just taking over the total care after an RD , Lucentis treatment etc. I have heard him lecture many times and he never disappoints. He told me after the conference how impressed he was with the platform and the depth of education. By coincidence he delivered the very same lecture the Monday after live and you missed nothing by doing it online. I recused myself from answering his questions of course not wanting to be a gunner with all the answers

Mark has been to my office. He's a great guy.

 

[AdminWolf]

I signed up. I am just watching more videos today. You guys did a nice job.

One question I have for Admin Wolf: Is there any way to speed up the playback slightly (I do this on MS Media player). I love the content, but find the real time playback sedating. Actually I have tried putting on some Vivaldi music quietly in the background along with an espresso, and I am feeling more energized. Just asking

We are constrained by what we can do, not technically, but politically

That is, the classes must be of a certain length in order for you to receive credit -- that's an ARBO requirement. We strictly play by all the rules, b/c we want to make sure that you get your credits.

Thanks!
ad

 

[AdminWolf]

I absolutely wouldn't do another one this year. Too expensive and that's the last habit you want someone to develop. All I meant was that it could have been earlier than many seek CE.

Maybe it might be interesting to evaluate any available metrics on when online CE is sought...but regardless, over 1300 giving good reviews is an amazing turnout and a testament to the support of this community.

I suspect in December, people -- in general -- aren't thinking about CE, they are thinking about Xmas.

Unless they are short a few credits. But I think it might make more sense to do this again in the winter sometime.

The question I have for everyone is -- when does the clock reset on the credits for most people? Is it January 1st?

 

[Joe DiGiorgio O.D.]

I suspect in December, people -- in general -- aren't thinking about CE, they are thinking about Xmas.

Unless they are short a few credits. But I think it might make more sense to do this again in the winter sometime.

I always hated that the AAO meeting was in December. Very bad timing for all but the CE renewal issue.

 

[Ronald Bodman]

I suspect in December, people -- in general -- aren't thinking about CE, they are thinking about Xmas.

Unless they are short a few credits. But I think it might make more sense to do this again in the winter sometime.

The question I have for everyone is -- when does the clock reset on the credits for most people? Is it January 1st?

Mine resets in June.

 

[Frederick Frost]

I suspect in December, people -- in general -- aren't thinking about CE, they are thinking about Xmas.

Unless they are short a few credits. But I think it might make more sense to do this again in the winter sometime.

The question I have for everyone is -- when does the clock reset on the credits for most people? Is it January 1st?

Ohio is 09/30.

 

[AdminWolf]

Ohio is 09/30.

Hmm.. i'm trying to get a sense here of when most states reset -- so January 1st isn't an important date for most?

 

[Marc Burcham]

In Ohio, hours must be obtained before October 1st of each year (I believe?).... And I do procrastinate.

Ohio does allow 10 hours of online CE... But I can get free online CE from Review of Optometry, and if there's a $20 or $35 dollar course I really want to do, I'll do that also. The number of "granted" (or free) CE the past couple of years has really increased.

In Cincinnati, I do 2 CE Sunday seminars provided through Diversified Ophthalmics every year (totaling between 16-18 hours for 2 Sundays a year... Normally one in April and the other in August), and the rest I do online in the fall. Often, the online CE I do after the last Sunday Seminar so I don't do an online course of something I have to sit through anyways.

If Ohio allowed all Online CE (won't happen with how successful there East-West is in Cleveland every year)... You can sure bet I would have signed up for CEWire2015 and got all 25 hours I needed. A MUCH better deal than paying $250 to Diversified twice every year, and yet still needing online CE on top of it.

 

[Frederick Frost]

I'd like to make a couple of comments to let you know what I think about the conference.

I am extremely satisfied with the quality of material. I'm also very glad that several people who contribute on here regularly free of charge, are being rewarded for their knowledge. I hope next year more individuals sign up and higher speaker fees which are well-deserved.

While I am only allowed to use technically 10 hours of this, that is not is why I have signed up. I'm going to do all 30 hours, and enjoy every minute of it. Everyone talks about the continuing education, but is not talking about the numerous things that the doctor will learn to help their patients. Some of these lectures are pure gold.

The on demand function was a great and still is very useful benefit of this. I have long commutes to some of my homes, and I literally will listen to a course in the car, and pull off the exit and do the test! That leverage of time is of great use to me and I'm sure others here.

Don't worry on how many paid people sign up for the courses, you did a fantastic job, and I know it will get even better. All 39,000 will never sign up just as all 39,000 never do the same things. That should be the least of your concerns. Just keep producing high-quality, with the increased convenience. Attendance will improve every year. Make sure you and Paul are also compensated for your time.

Thanks for doing it.


Fred


Fred

 

[Steve Silberberg]

Thanks Fred for the nice comments. I helped Paul and Adam out in this endeavor and believe me they worked like dogs before, during and now after the live conference. A lot of problems and a alot of coordination + Adam traveling to conventions like VEE to solict vendors. The speakers were wonderful but technical challenges also arise. Adam spent tons on the equipment to produce the live feed. Imagine them talking for 7 hours 2 days in a row...........Amazing!!

 

[Richard Frankel]

Now. We need to exploit the potential for this technology to its fullest. National symposiums could truly be national in reach. Today, I was talking about a day long conference on diabetes. It would start with general medical and go into DR at the end of the day. Now, if it was simulcast over the ODwire infrastructure...

 

[Donald bader]

CEwire2015 by all measure for a first attempt was a success. Having 1300 register and eventually take over 30 hours of COPE approved CE is gratifying.

However, that represents a minuscule number of ODs who require C/E for re-licensure. How about the 39,000 of you who did not register? Where did ODwire.org fail?

Did the message go out and received by all ODs? If not how do we reach these folks?

Were the courses varied enough to allow choice for ODs tired of same old, same old C/E. What courses and speakers should be added if there is a CEwire2016?

We appreciated the vendors who supported our first attempt without knowing if there even be an audience. I think vendors were pleased by our support to make ODs aware of their booths. I hope registrants attending live, visited the booths asked questions and took advantage of the discounts scheduled to expire on 5/31/15.

Now the challenge...how to attract the deep pocket vendor big boys, who spend over six figures at live C/E events to show their support. this would allow hefty contributions to our designated charities. Some won't advertise on ODwire.org because of our policy of allowing vendor criticism. CEwire.org is different and free of debate. Time for Corporates to "belly up to the bar" and show support.

For those who have not as yet signed up for CEwire2015, please share why. For sure the under $5 per credit hour without the need to travel is inexpensive as you will find for C/E.

What can we do to attract you 39,000 for the next three months of CEwire2015 and then CEwire2016?

If we could have a written presentation as well as the video it would be very helpful.

 

[Paul Farkas]

If we could have a written presentation as well as the video it would be very helpful.

You would like the speaker's power point presentation? Interesting...what is it worth to you to have a hard copy?

 

[Jonathan Warner]

Ohio is 09/30.

I did not sign up because I already had all the hours and more that I needed for this CE year. I don't need any more until 10-01-15. Then I would be very interested.

 

[Steven Nelson]

I did not sign up because I already had all the hours and more that I needed for this CE year. I don't need any more until 10-01-15. Then I would be very interested.

You'll be 2 months late, punchy

 

[Joe DiGiorgio O.D.]

Has anyone already asked. Is there a way to get the presentation by April Jasper, OD, to run?

Thank you.

 

[Chuck Barnes]

Some state boards limit online ce hours

 

[Paul Farkas]

Has anyone already asked. Is there a way to get the presentation by April Jasper, OD, to run?

Thank you.

We are contacting Dr Jasper. She recorded the entire lecture and there was no sound.

She must resolve her technical problem and then decide whether to do the lecture or wait until next time.

Either way CEwire2015 has the 30 hours promised. We added an extra hour for this type of eventuality.

 

[Paul Farkas]

Some state boards limit online ce hours

Sad but true.

ODs in a given state must ask their state board to increase their on line CE hours or explain why not. For example, Florida does not allow any on line CE credit.

The exam at the end for C/E credit combined with the "On Demand" feature assures participants will learn the material by allowing a re-visit to the course. Compare that to an in person attendance without the need for an exam to determine if the material was learned.

 

[Michael W Ohlson]

Sad but true.

ODs in a given state must ask their state board to increase their on line CE hours or explain why not. For example, Florida does not allow any on line CE credit.

The exam at the end for C/E credit combined with the "On Demand" feature assures participants will learn the material by allowing a re-visit to the course. Compare that to an in person attendance without the need for an exam to determine if the material was learned.

Your "explain why not" phrase is important.

We're at a place where we have some information re. physician learning and effective CE.

Traditionally, showing up to a grab a seat and listen passively or read the newspaper (those flimsy sheets of wood-based material with ink marks on them) while whoever was speaking on whatever topic, relevant or not, hasn't been shown to be terribly effective.

While far from perfect, some tweaks in design help. The methods can easily be adopted in optometry. They require a different thought process and a bit more effort. Nothing extensive or impossible or needless. Other major health care professions already use them. We can catch up and should do so IMO unless our patients are less important and our profession is uniquely above criticisms from the outside. Or perhaps our physician-learners don't mind paying for less effectiveness or wastes of time. I doubt that.

ARBO held a large meeting of CE stakeholders in Chicago a few years back. One of the speakers was a big name in said physician-learner theory.

Yes, we're nerds. I'm aware.

The learner theory aspects can be utilized in pretty much any method of delivery.

Charged with protecting the public, the state boards/jurisdictions should demand the most effective CE for MOL, free of commercial influence, with valid content, aimed at improving knowledge, performance in practice, and better outcomes. To choose otherwise... what does that say? Does it come with risks?

Obviously, there are many stakeholders. I know. I get it. I'm familiar with the various uses and benefits in CE. In addition, some CE providers are small in size. Labor and capital are relevant. Totally see it. Look at where I live.

Regardless, the challenge is here now. A while back, actually. Not new in health care. Not caring about it and not knowing anything about it... not really excuses.

 

[Steven Nelson]

Your "explain why not" phrase is important.

We're at a place where we have some information re. physician learning and effective CE.

Traditionally, showing up to a grab a seat and listen passively or read the newspaper (those flimsy sheets of wood-based material with ink marks on them) while whoever was speaking on whatever topic, relevant or not, hasn't been shown to be terribly effective.

While far from perfect, some tweaks in design help. The methods can easily be adopted in optometry. They require a different thought process and a bit more effort. Nothing extensive or impossible or needless. Other major health care professions already use them. We can catch up and should do so IMO unless our patients are less important and our profession is uniquely above criticisms from the outside. Or perhaps our physician-learners don't mind paying for less effectiveness or wastes of time. I doubt that.

ARBO held a large meeting of CE stakeholders in Chicago a few years back. One of the speakers was a big name in said physician-learner theory.

Yes, we're nerds. I'm aware.

The learner theory aspects can be utilized in pretty much any method of delivery.

Charged with protecting the public, the state boards/jurisdictions should demand the most effective CE for MOL, free of commercial influence, with valid content, aimed at improving knowledge, performance in practice, and better outcomes. To choose otherwise... what does that say? Does it come with risks?

Obviously, there are many stakeholders. I know. I get it. I'm familiar with the various uses and benefits in CE. In addition, some CE providers are small in size. Labor and capital are relevant. Totally see it. Look at where I live.

Regardless, the challenge is here now. A while back, actually. Not new in health care. Not caring about it and not knowing anything about it... not really excuses.

What are some examples of what "they" do that we're lacking? I don't mean in terms of objectivity because removing commercial bias SHOULD be a given. I'm talking more in terms of actual delivery of CE. More online with testing? Tests at live presentations?

What are they doing that we need to emulate?

 

[Michael W Ohlson]

What are some examples of what "they" do that we're lacking? I don't mean in terms of objectivity because removing commercial bias SHOULD be a given. I'm talking more in terms of actual delivery of CE. More online with testing? Tests at live presentations?

What are they doing that we need to emulate?

First, the stds (requirements) of commercial support for optometric CE to reduce bias, a no-brainer, were fought tooth and nail by almost everyone even after public actions and records of the SFC, announcements, calls for comment, delays, two nat'l educational mtgs, and so forth. Find some real evidence that optometry thought they were a good idea and realized they were necessary. Good luck. You won't. It was humiliating for the profession and remains so. A black mark.

As for CE, we do some things well and there's no need to emulate anyone else (sounds bad to some, like an insult; sensitive folks) so much as attain community standards. So, that's a plus. CME/CE has plenty o' critics. Lotta politics. The IOA does an excellent job at CE. Others, too.

Not all. Think "all" for a few minutes, just for an exercise. Think about all the CE in every jurisdiction, the good, the bad, and the ugly. Perfection ain't easy, of course. Think about the patients. Vision, eye disease, and related systemic conditions. Think about the OD-learners, the actual profession.

To your point, several aspects of learner theory appear applicable. The papers are kinda long. I'll be curt. It actually demands homework. At least it did for me.

Obviously, there will be skepticism, push-back, what-ifs, fear, revulsion, outrage, and so on. Mainly confusion and jumping to unfounded conclusions or absolute denial of any dilemma based upon not knowing better or fear of change. I know. I didn't invent it. I report the science and the standards. What individuals in optometry believe and do is up to them, of course.

All education is a work in progress.

"Start with the end in mind." Not my words. Knowledge gaps exist in health care. This is not a criticism of medicine or optometry or any person. Just is. A gap can be thought of as a problem. Let's say that opiates kill people and that some of that can be addressed by altered procedures in care. Not all, some. Gap. If "problem" seems too judgmental and that scares someone, call it a situation. It's not an invasive procedure.

The other aspect is to address effectiveness. That's a bit different than "Did you enjoy the meeting? Was the food okay?" However, it does not mean there must be a test. You might have noticed that MDs and ODs aren't that pleased with testing and that a lot of testing doesn't really indicate performance in practice. Surveys might be a method to see if practice patterns were altered. And, the answer may be 'no.'

Relevance is important. Given that some standards are just central, certainly, like DFE and diabetes (or apparently just DFE... sonnuva... I digressed, sorry), other areas of practice might be relevant to one OD and not to another.

Turns out we don't do well at self-assessment. Stink. That's for MDs, not ODs; no OD research exists. In addition, the lower 25% ranks themselves as "above average" in competence. Consistently. Again, MDs. But, humans are humans and I see us as doctors. My post, my rules.

Some techniques work better than others. I learn by doing. Didactic is pretty much wasted on me. But, that's a bit ahead of the game. Technology will change and so will everything else. Simulations work.

The concept is one of moving health care forward, not just optometry. It's already here. Now.

One can measure CE from the lowest level of effectiveness, attendance, to the highest, improved community health. Most will fall short of the top and by design. Hard to attain.

I understand that politics will take ugly turns (has now) and people are burned out/stressed (costs, hoops, EMR, ICD-10, VCPs, etc.) and paradigms enter into it... blah, blah, blah. Just the situation. Money. Avarice. Fear. Paranoia. Envy. Vengeance. Whatever. I can't stop that. Not in my control. I stopped caring, swear to God. I hope we make good choices. This time.

I will try to control that which I can control to make good, independent accreditation work for the optometry patients and the providers, particularly the small ones. It can be done.

Fairly simple adjustments have been proposed for optometry that increase effectiveness. Over 2700 CE providers already voluntarily do this type of thing.

It's a bit more thought and effort to CE. The benefits, particularly for the fairly easily attained knowledge gap and effectiveness aspects (again, takes a bit of thought and will; doable) outweigh the costs. Unless our patients and OD-learners don't matter.

My experience in speaking to others that did the same thing is that it all worked out after a bit of adjustment. We can do it and we should. For the patients. For ourselves.

It's not that new. It's new to some ODs.