Remember when we were told that there was no way that Obamacare would result in driving up costs of healthcare, and in fact would lower it? Well, that ship has already sailed. But there was another popular “myth” which many of us were accused of falling for. It was the prediction that government meddling in cost setting would drive health care professionals out of business resulting in less available services and a subsequent decline in quality of care. That was just a myth, right? Ah, good times… good times….

Unfortunately, the early projections show that precisely such a result is already kicking into gear.

The Affordable Care Act (ACA) has recently triggered a debate within the medical community about both its potential impact on medical trainees and on practicing physicians. While the president of the American Medical Student Association has publicly supported the changes in a recent official memo, a recent survey indicates that 40 percent of medical students may not even be aware of the provisions of the act.

Institutional changes can often be double-edged swords, and this series of proposed changes is no different. There are both potential benefits and downsides to what is now widely seen as almost inevitable healthcare reform.

How is this playing out in the real world? One area of medical practice which seems particularly vulnerable is eye care. A shortage of certified, fully trained ophthalmologists is tempting some states, like Kentucky, to expand the practice of optometrists to fill the gap. But there are problems with that.

Kentucky joined the company of Oklahoma last week as the second state to conflate optometrists and ophthalmologists. Only ophthalmologists are the sort of doctors who graduated from medical school, did an internship, completed a three-year residency in eye surgery, possibly a fellowship after that, and have achieved and maintained national board certification through a program of lifelong learning in their specialty.

Optometry schools (four-year programs focused on optics to prescribe glasses and contacts and the diagnosis and management of certain eye-related diseases) have a tough application process too, and many of the same students going into optometry could have chosen medicine. But nobody ever really faces a clear-cut choice of going into optometry or ophthalmology.

I’m not knocking optometrists here. I see one on an annual basis myself and they provide a very important service to those of us who wear glasses. But they’re not ophthalmologists, and the difference in skill levels and training between the two disciplines are pretty vast. When we start conflating the two in order to cut costs and make up for a lack of board certified eye doctors, problems arise.

Just two months ago, Vickie Patterson said her daughter Victoria began experiencing double vision.

“I wasn’t overly worried,” Vickie said, “because she’s far-sighted, but we went to the optometrist when it didn’t go away.”

The optometrist diagnosed Victoria, 9, with weak eye muscles.

A trip to a pediatric ophthalmologist, however, resulted in an MRI.

“On Nov. 17,” Vickie said, “she had the MRI, and on Nov. 18, we learned that she had two masses on her brain, one of them on her brain stem.”

Unfortunately, when you start talking about cutting costs in government managed health care, one of the first groups to get hit is always our veterans. And they’re apparently paying the price for it with their vision.

California veterans go blind due to bad care from optometrists “practicing beyond their scope”

A Veterans Administration probe found that eight veterans at a Northern California VA facility suffered potentially-preventable vision loss while under the care of optometrists, according to the Associated Press.

Optometrists have four years of college, and four years of graduate education. They’re cheaper to see, and more widely available, than –

Ophthalmologists, who are medical doctors and can perform surgery. These folks have four years of college, four years of medical school and four years of residency and internships relating to the diagnosis and treatment of eye diseases.

Of course, everyone who predicted just such results were a bunch of paranoid, Obama hating wingnuts. Sadly, they also appear to have been rather prescient. If the government control of the health care system makes it unprofitable for students to go into medicine or for doctors to continue in their practices, something’s got to give. I don’t know how many more parallel fields of medicine may crop up where people begin to rely on the services of less than qualified professionals, but the forecast isn’t looking good.