Health policy initiatives create ‘manpower shortage’ in ophthalmology

SARASOTA, Fla. — Health policy initiatives that discourage specialization have not only failed to reduce health care costs, but they will ultimately create a manpower shortage in specialties such as ophthalmology, according to William L. Rich III, MD.

Since the 1970s, health policymakers have attempted to control the cost of health care by rewarding generalists, said Dr. Rich, chair of the American Medical Association/Specialty Society RVS Update Committee.

Ophthalmology is an example of the failures of these policies, he noted here at the American Glaucoma Society meeting.

Data show that ophthalmologists are losing an increasingly greater market share to optometrists, who in turn benefit from Medicare reimbursements that encourage in-office procedures rather than surgical procedures, according to Dr. Rich.

In the past 3 years, the number of established ophthalmic patients fell from a once-steady 85% to 78%, he said. Specialists have been particularly hard-hit during economic downturns, when patients are more likely to seek care from generalists, he added.

Ophthalmologists, meanwhile, are providing 8.6% more services per patient, he said.

These factors have contributed to a falloff in the number of medical students applying for residencies in ophthalmology, Dr. Rich said. As the population ages, patients will be faced with a shortage of trained ophthalmologists.

Generalists do not necessarily reduce health care expenditures. Optometrists, for instance, are 10% more likely to bill for Level 4 procedures, Dr. Rich noted.

“I think we have a bad business model,” he said, adding that the reimbursement changes have created “de facto centers of excellence.”