Obvoiusly, we disagree

You bring up pharmacokinetics specifically, but there's a whole lot
behind that.  While we're not your "typical" med school curriculum, I
can point you to our site.  While atypical, the content is strictly
regulated.  It might be repackaged, but it teaches the same stuff as
every other US med program.

http://www.urmc.rochester.edu/smd/CA/dh/DhMap.pdf is the time line
with
http://www.urmc.rochester.edu/smd/CA/dh/principles.html#outline
being sort of a key

Essentially the whole first year has three courses running through it.
1/3 the work is basic anatomy, physiology, and histology.  Of the 2/3
remaining, I'd say about 10-15% of that is pharmacology.

Year 2: 1/3 the neurosciences, w/ neuropharmacology taking about 10%-15%
of that.  The rest of Year 2 is integrated systems, with the relevant
pharmacology discussed within the context of the system.
Pharmacokinetics is a major portion of the renal systems discussions.

With specific reference to pharmacokinetics, the training OD might get a
tad more specific coursework, but when you throw in pharmacology taught
in context of the affected systems and physiology, there's a good bit of
that. Add to that the idea that the intensive physiology can only add to
the mechanistic understanding of drug action.

The comanagement arrangement has been ethically borderline since its
inception.  There's a ton of literature on it, and I'm sure you've read
a good deal of it.  I'm pretty sure I recall that years back you shared
some of your views on it in this forum.  After a few years of a big free
for all, HHS expressed real concern, and some of the professional
societies came up with some guidelines which may or may not be all
encompassing.  It's not hard to come up with some challenging situations
for an OD to find himself in. Googling for "lasik comanagement ethics"
yields a fine number of hits.

Try http://archopht.ama-assn.org/cgi/content/full/120/1/71 for a good
2002 review, if you can get in without a password.

Yes, comanagement can work well for the patient, but the financial
benefit of sending a surgeon referrals cannot be ignored.  You mention
the greed of the OMD, but I'm sure you wouldn't have to search too hard
to find a greedy OD or two, especially from the wild days before
guidelines were published.  

To your credit, in 2000 you said "Having
said that, I also admit to feeling the financial pressure to encourage
people to take the leap into LASIK because I do make money from it, but
at least that human frailty is tempered by the knowledge that if the
patient has a bad outcome, I'M THE ONE TO WHOM THEY WILL BRING THEIR
COMPLAINTS. This might be one reason the surgeons I work with have
embraced this paradigm.  You might say  we are buffers both before and
after the fact."

Interestingly enough, one of the real problems with comanagement is that
if not careful, the patient could feel that the ultimate responsibility
for postop care lies with the OD.  The AAO's clear position is that it
must be made perfectly clear to the patient that the surgeon has ultimate
responsibility for the care.

In 1998, you wrote "This co-management thing is a new incentive, indeed.
If the money skews the O.D.s thinking about what's best for the
patient, that's a real shame. I agree with the idea that if a doc (any
type) PUSHES hard for a patient to buy into ANYTHING that is obviously
optional, run, don't walk, out of the office. "

Here's our Vision Center's policy on comanagement, from their FAQ:
"Can you work with my regular eye doctor?
In order to make the process of care as comfortable as possible for you,
we offer to co-manage with your current ophthalmologist or optometrist.
You may choose to have your pre-operative evaluation, treatment and one
day post-op visit at StrongVision with the balance of your post-op care
provided by your personal eye doctor. If you would like to do this, we
will reduce our surgical fee by a set amount per eye treated and your
personal eye doctor will charge you a separate fee for their care. Please
discuss this option with your eye doctor prior to the time of your
evaluation. "

The original poster complained that the surgeons buddied up to the OD's
because they thought that the OD's served as recruiters for the
procedure.  Frankly, if that's really the case, to quote Mel Brooks, "it
stinks on ice", and there are no innocents.

To a certain extent.  I'm a WHOLE lot more concerned about dentists using
dental anesthesia.  If I EVER need dental surgery requiring anesthesia, I
will find a dentist that uses a real live anesthesiologist.  Oddly
enough, many dentists would agree with this.

As to antibiotics, dental patients might not always be getting the
optimal agent, and the use of dental antibiotics for prophylaxis is
probably over the top.  Aside from that, the use of dental antibiotics is
fairly routine.    Pain killers, of course, are a matter of practicality
for dentists.

Now, let's look at the differences between anesthesia and antibiotics.  
Antibiotics are fairly routine.  Even so, there are a certain number of
things to ask about before prescribing them, like allergies.  If the
patient has an allergic reaction, the doctor will treat it, not the
dentist.  Other than that, they're relatively safe.

Anesthesia is a different story.  Anything can happen.  An
anesthesiologist will understand osmotic balance, the homeostatic
regulation thereof, and whether isoosmotic or hyperosmotic IV solutions
are called for.  An anesthesiologist will understand acid-base
regulation, and the involvement of the respiratory system and the renal
system in this regulation.  An anesthesiologist will maintain the plane
of anesthesia at the lightest level appropriate for the procedure, and
dedicate full attention to the patient, not splitting his time between
the patient and the dental procedure.

We can both agree that there should be a fuzzy line somewhere that
separates the therapeutic options of the opthalmologist from the
therapeutic options of the optometrist.  Where is this?  Should the OD
have the whole PDR at his disposal?  If an OD sees pale spots on a
retina, should he request an MRI and prescribe interferon based on the
findings?  We're probably both safely in the "No" circle here.  Should an
OD treat a papiloedema?  Retinal bleeding?  Acquired nystagmus? When a
patient comes with migraine aura, should you treat the migraine?

Just out of curiosity, what therapeutic options is the OD community
lobbying for that they don't already have?

I worked for a full time ophthalmology practice at one time and for a
practice that is primarily optometric with general ophthalmology approx.
once a week.  I think that ophthalmologists and optometrist both have
different qualities to offer.

The primary differences I have noted are that ophth M.D.'s focus on the
patient's eye and total health.  They feel comfortable treating more
complicated cases.  While the O.D. does a thorough job at finding and
diagnosing eye diseases, he isn't always comfortable with following them and
often refers them to a specialist or the general ophthalmologist.  Also the
O.D. focuses a little more on eyeglasses prescriptions.  Perhaps that's
because as an O.D. income is generated from glasses sales and not from
surgery as an M.D.'s??

In reading some of the ophthalmology journals I understood the tension
between O.D.s and ophthalmologists to be due to the fact that O.D.s were
trying to get (laser) surgical privileges, not so much prescribing rights.

We have good O.D./ophthalmology relationships in our area. Sometimes the
O.D.s who get a little competitive amongst themselves.

EyeTech

We've had many debates on this newsgroup about HMOs vs private practice.  
One thing I like about my HMO is that there is no competition between
ODs and MDs.  They are both on salary, and losing a patient for a
procedure involves a loss of workload, not a loss of money.  The eye
clinics are staffed roughly half with ODs and MDs.  They share the staff
and office space (although not exam rooms, I suspect).  Although the MDs
have phoropters in their exam rooms, they very seldom do refractions.  
Those are referred to the ODs.

A new patient *cannot* make an appointment with an MD.  They must be
referred by an OD.