Manpower needs, shortages altering primary care in ophthalmology practices

When it comes to manpower and shortages of ophthalmologists in the United States, "there's no magicbullet but it's really looking internally into our profession [and] our individual practices withanswers to a lot of manpower needs," said William L. Rich III, MD, medical director for healthpolicy, American Academy of Ophthalmology.

At a Nov. 11 symposium, Dr. Rich filled in for Bradford Singleton, MD, and spoke about the shortageof ophthalmologists and the trends of more comprehensive practices in "integrating optometrists andother physician extenders versus competitive fragmentation of eye care delivery: the challenges ofnon-physician patient care.

"We have a small blitz during this period [of] about 15% that is expected to end as the baby boomersretire, but even with that increase, we have a decrease of ophthalmologists," Dr. Rich said. "Evenwith Medicare that shortfall is dramatically greater."

There will be a 20% increase in Medicare beneficiaries by 2010 and that will bedoubled by 2040, Dr. Rich forecasted. The elderly are driving much of this. Dr. Rich added that theincrease in intensity of services given to patients and influences of new technology also have a handin this issue.

Some indirect evidence of the manpower shortage is that there is a loss in office visits, according to Dr. Rich. Patients cango to optometrists for basic eye care, he said. With the shortage of physicians the demand is not beingfilled. The percentage of ophthalmologists employing ODs increased from 28% in 1995 to 43% in 2005, he added.

Optometrists may prefer to work with an ophthalmology practice because they offer a higher-paying salary and abetter lifestyle, and there is a sense of professionalism associated with it, he said. There is asharing of ideas and patients that both the ODs and ophthalmologists enjoy, according to Dr.Rich.

There is a risk that ophthalmologists will face a long-term problem that primary care is facing now, he said.Sixty-one percent of practices are comprehensive, except for younger physicians who make up part of the19% that are not comprehensive. Therefore, ODs will become primary-care providers by default,according to Dr. Rich.

The future trend is that there will be more and more ODs in practices.

"It's not going to be a new paradigm sent down from above," Dr. Rich said. "It's going to be sharedideas and shared models with more integration of our practice."