This article is more than 5 years old. Information may no longer be current.
Integrated eye care model can help with possible shortage of ophthalmologists
Click Here to Manage Email Alerts
 Richard L. Lindstrom |
The ophthalmologist finishing his or her training today in the U.S. is destined to confront an interesting array of challenges.
Our population is aging, and the number of patients over the age of 65 years will grow every year for decades. This is important because many of the diseases we ophthalmologists treat are age-related. These include the most common medical and surgical problems encountered daily by the comprehensive ophthalmologist: cataract, glaucoma, dry eye, blepharitis, age-related macular degeneration and diabetic retinopathy, to name only a few.
All agree the demand for eye care services is going to grow significantly every year for as far ahead as we can see. This is great news for ophthalmology. There will definitely be no shortage of patients to treat.
Still, some concerns become apparent. First and foremost: Who is going to treat all these patients? There are currently about 18,000 ophthalmologists in the U.S. If we assume a 35-year career from age 30 to 65, about 3%, or 540, would be expected to retire every year. Because only approximately 450 new ophthalmologists complete training each year, it appears that we will have fewer ophthalmologists to treat more patients with more problems.
In addition, the classic male baby boomer work ethic usually led to 50- to 60-hour work weeks. It is not certain that the next generation of ophthalmologists, with more than 50% being women in their child-rearing age, is going to match this arguably out-of-balance approach to life. It is possible — no, probable — that we will experience another 10% to 20% reduction in ophthalmologist work output as 60-hour-per-week baby boomer surgeons transition to their younger colleagues who desire a 30- to 40-hour-per-week work schedule.
Every year, new treatments become available, increasing the demand for surgery. When I completed my training 33 years ago, about 10,000 anterior segment surgeons performed about 1 million to 1.5 million surgical procedures a year, or 100 to 150 per surgeon per year on average. Today, about 9,000 anterior segment surgeons perform at least 5.4 million surgical procedures each year for an average of 600, and the number grows every year. Clearly, even considering the increased productivity of today’s surgeon, there is less time for office practice.
So how do we take care of all the patients in the office who seek our care? The answer, to me, is we hire care extenders to help in the office. The certified ophthalmic assistant, ophthalmic technician and ophthalmic medical technologist immediately come to mind. In our practice every ophthalmologist in the clinic is supported by three or four of these valuable employees, allowing us to see eight to 12 patients an hour rather than four to six.
If every ophthalmologist in America hired three or four technicians, we would need more than 50,000 of them. Unfortunately, there are far fewer available and no evidence of an increasing effort to train more. Nurses will and do help, but we all know that there is an incredible shortage of nurses nationwide as well. In some offices, opticians help outside the dispensary, but most are fully occupied supporting the optical shop in practices where they are located. Physician assistants and nurse practitioners are a thought, but they are rare, expensive and usually prefer general medical practice. In some practices, including ours, retention of senior medical ophthalmologists is a very productive asset.
The obvious answer, to me, is to engage our optometric colleagues in a care delivery model that is collegial, collaborative, professionally fulfilling and very efficient in providing a large volume of quality care. I have termed this approach the Ophthalmologist Lead Integrated Eyecare Delivery model, or OLIED model of eye care, and our practice, Minnesota Eye Consultants, is one example.
We have six anterior segment partner surgeons who practice in collaboration with 12 optometric and four medical ophthalmologist employees and two fellows. This is a 3:1 non-surgeon doctor-to-surgeon ratio. At Minnesota Eye Consultants, this allows us to see well more than 60,000 patient visits a year and perform more than 15,000 surgical procedures, including lasers. We are not alone in leveraging this eye care model, as when I started in practice in 1977, less than 5% of ophthalmologists employed an optometrist, whereas today more than 50% do so. This model of integrated eye care, including the collegial, cooperative management of patients by surgical ophthalmologists, medical ophthalmologists, optometrists, ophthalmic assistants and technicians, opticians, nurses, occasionally a physician assistant or nurse practitioner, and a talented certified ophthalmic administrator is, in my opinion, well-suited for the challenges of the future.
I believe it is time for our professional societies to embrace this model as an appropriate alternative, educate those interested in how to best leverage its amazing capabilities, and advocate for it as an alternative to the separate but equal model of ophthalmic and optometric practice.