To the editor
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We read, with great concern, the recent article regarding workforce challenges in pediatric ophthalmology (Healio/Ocular Surgery News, Jan. 25, 2023, page 1).
The article focuses on reimbursement decreases, decline in pediatric ophthalmology fellowship match rates, and access to care for specialized pediatric eye care and strabismus management, but the headline labeling this an “economic crisis” with “disillusionment” is not only negative, but one-sided. As we all are aware, the information in the article is based on several surveys, which can include inherent bias. American Association for Pediatric Ophthalmology and Strabismus leadership created a Recruitment Task Force recently, which stemmed from discussions about workforce issues during a strategic planning meeting. This task force has dedicated AAPOS members, in all stages of their career, working diligently to address the very issues this article outlines. These initiatives include sharing the rewards of our subspecialty at an earlier stage in medical training, particularly to medical students; creating shadowing opportunities with private practice and academic mentors; establishing scholarships for medical students and ophthalmology residents to attend our AAPOS annual meeting, with an all-time high registration of these trainees for our upcoming spring meeting in New York City; creating hybrid fellowships to train pediatric ophthalmology with adult cataract surgery for residents who want to practice both comprehensive ophthalmology and peds; and encouraging residency program directors to be positive and share accurate salary information to residents interested in our subspecialty.
The AAPOS board of directors hired a lobbying firm for the first time, which is creating long-term goals to help improve reimbursement for our members. Our Socioeconomic Committee, led by Dr. Eric Packwood, has surveyed our membership on compensation, and we will have accurate financial data in a few months. At last year’s American Academy of Ophthalmology meeting, the AAO Young Ophthalmologists (YO) committee showcased pediatric ophthalmologists in a panel for medical students and residents, and they reported highly competitive salaries. Painting a picture that a pediatric ophthalmologist practicing in 2023 cannot earn a living is a myth that should not be perpetuated.
Finally, and most importantly, it is the responsibility of editors who publish articles on our subspecialty workforce challenges to share the full story, not solely what draws readers by evoking negativity or inflammatory labels. The AAPOS membership cares deeply about the future of our field, and it truly has been amazing to see our members invest time and initiate creative solutions in our task force initiatives. We particularly owe our YO members who have a long career ahead of them the best possible working opportunities with sustainable economic solutions. We view this as a challenge we will positively and steadfastly face and not dwell on negative, biased articles.
Yasmin S. Bradfield, MD
Chair AAPOS Recruitment Task Force
Robert S. Gold, MD
AAPOS President
Christie L. Morse, MD
AAPOS Executive Vice President
The editor responds:
Every subspecialty in ophthalmology is facing an ever more challenging external environment. Healio/Ocular Surgery News believes it is in every ophthalmologist’s best interest to openly discuss these challenges and offer potential responses to mitigate them. Dr. Bradfield, Gold and Morse have strengthened our mission with their thoughtful letter.
Richard L. Lindstrom, MD
OSN Chief Medical Editor
The study authors respond:
We thank Drs. Bradfield, Gold and Morse for their letter regarding our article recently published in Healio/Ocular Surgery News.
First, we want to be clear that we are on the same side with the common goal of improving access to pediatric eye care, particularly in the most underserved areas of the nation. If the factual reality of our economic situation is not presented, it will be challenging to expect governmental agencies to sympathize with our cause of improving reimbursements for pediatric ophthalmologists. Omitting data or sugarcoating facts will prevent us from presenting the complete true picture of our economic situation, which governmental officials need in order to move forward.
With this framework in mind, we would now like to address each point raised.
“Disillusionment” is not only negative but one-sided: We distributed an anonymous survey on the AAPOS discussion board, pediatric ophthalmology Facebook group and pediatric ophthalmology listserv, which revealed that 37.8% of pediatric ophthalmologists would not recommend residents pursue a pediatric ophthalmology fellowship. Clearly, many of us feel disillusioned, and to hide or sugarcoat these data will only detract from our ability to achieve the proper response from governmental officials. They need to understand the struggle that many of us are experiencing in order to improve reimbursement and other related workforce issues, which will ultimately impact access to eye care. Contrary to the “negative” headlines of our article, we have received numerous positive responses from pediatric ophthalmologists congratulating and begging us to continue our important work. These include feedback that our “team has comprehensively addressed our challenges and drawn attention to the solution” and that our compelling articles “shine a light on our challenge.” Others have “expressed great admiration and appreciation and are certain this sentiment is shared by all of the members on the AAPOS listserv. Kudos (squared!).”
Despite numerous communications via email, Zoom meetings and phone, Drs. Gold and Bradfield do not seem to understand that our data and next three articles to be published in Journal of Pediatric Ophthalmology & Strabismus will assist AAPOS in its strategy of supporting changes through lobbyist efforts to improve the economic issues within pediatric ophthalmology.
“Bias” of our surveys: Our surveys were distributed to the aforementioned fora. Responses remained anonymous; therefore, results were not biased. We had also communicated with the AAPOS leadership to have the board complete our survey in order to garner responses from AAPOS leadership, who all had multiple opportunities to share their input.
In summary, we emphasize that our work and next three articles are needed to assist AAPOS in its efforts to improve economic reimbursements and access to eye care. To suggest that we do not care deeply about our field is unfounded, and we must work to realize our common interests and shared goals.
Karen E. Lee, MD, MS
Bradway Research Fellow in Pediatric Ophthalmology
Wills Eye Hospital
Leonard B. Nelson, MD, MBA
Co-Director, Pediatric Ophthalmology Service
Director of Adult Strabismus Center
Wills Eye Hospital