The implications for ophthalmologists during a bad economy

Experts in the "dismal science" of economics debate, in newspapers and on the airwaves, the likelihood of recession. For ophthalmologists this means more uninsured patients, patients with less money to spend on things like multifocal IOLs, and less money in the practice to spend on needed equipment.

As I write this, experts in the "dismal science" of economics debate, in newspapers and on the airwaves, the likelihood of recession.

The price of oil has topped $100 a barrel, representing a financial drain on many Americans.

Home sales are way down, with prices dropping as well. Many Americans purchased homes they could not really afford, sometimes aided by creative financing involving no down payments, negative amortization, and "teaser" interest rates destined to shoot up after an initial period. In some markets, 20% to 30% of home purchases were purely investments, with the buyers having no intention of ever moving into the home. Instead, the idea was to wait and then sell at a big profit. Banks and major financial companies are now in trouble because of increasing defaults on those mortgages.

Particularly worrisome is the status of employment in the United States. Our unemployment rate recently increased from 4.7% to 5.0%. According to Bureau of Labor Statistics figures, last month 49,000 construction jobs and 31,000 manufacturing jobs disappeared. There was an increase of 31,000 in government jobs, countered by a loss of 13,000 positions in the private sector, for a net increase of only 18,000. That is a low number for job creation, and one that has ratcheted up the concerns that we are headed for trouble.

Service sector

Here's an interesting tidbit. No matter how bad the job situation gets, it seems new jobs are continually being created in three locations-restaurants, bars, and hospitals. That reflects, according to one observer, "our new economic model: eat, drink, and check into the hospital."

As a worker in the service industry known as medicine, it's nice to know that we continue to produce lots of jobs. One wonders, however, whether it is sustainable for a country to shed, month after month, the jobs in which people make things (like cars and electronics) and continue to grow the jobs of baristas in coffee shops; bartenders; waitresses; and doctors, nurses, and technicians for hospitals.

It also strikes me that those employment data highlight the ballooning (please pardon the pun) problem of obesity in the United States. It's as though the numbers show that we employ people to satisfy the excessive appetites of Americans, and then hire the doctors and nurses to address the consequences.

For ophthalmologists

What are the implications for ophthalmologists?

On a personal note, I hope we avoid the pain of a recession, so we don't have many parents coming home to tell their families that they lost their job that day.

On a more theoretical level, can a country really do well when all the new jobs are either in the government, bars, restaurants, or hospitals? Don't we need to make things anymore? I did not take any economics courses in high school or college, but the long-term trends in employment in this country seem problematic.

By Peter J. McDonnell, MD director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times.

He can be reached at 727 Maumenee Building, 600 N. Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu

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