Clinician: Health care reform could increase rate of retiring ophthalmologists, necessitating increase in ophthalmology residents

Issue: November 25, 2009

SAN FRANCISCO — In the next 20 years, more ophthalmology residents will be needed to replace the retiring ranks of physicians, many of whom might leave the profession earlier because of new health care policies, a clinician said here.

"Uncertainty about physician payments in the new world of health care reform will accelerate the exit rate," Carmen A. Puliafito, MD,MBA, said at the joint meeting of the American Academy of Ophthalmology and the Pan-American Association of Ophthalmology.

"I think that is a huge issue [and] ... when they talk about health care reform, no one really talks about manpower. It is really, all in the end, about physicians. And ophthalmology, unfortunately, will be especially affected by changes in Medicare reimbursement."

The number of ophthalmology residents has significantly decreased since 1985, Dr. Puliafito said. About 400 new ophthalmologists enter the field every year. That amount is not enough to treat the aging population and rising disease rate as baby boomer physicians retire, he said.

In addition, half of all ophthalmologists consider themselves specialists, reducing the amount of comprehensive ophthalmologists, Dr. Puliafito said.

The American Academy of Ophthalmology has been concerned with the evolving manpower shortage for the last 5 years. Our supply is stable in the face of a demand for a doubling of major ophthalmic surgeries by 2016. To increase the number of ophthalmic residency positions is an imperative, but there is opposition from primary care to give up any training slots. We have to increase the efficiency of our current practice models. I agree with Dr. Puliafito – the greatest demand is for comprehensive ophthalmologists and fewer graduates of training programs wish to pursue this type of practice.

– William L. Rich III, MD, FACS
AAO Medical Director for Health Policy