Second in a four-part series
By Richard Edlow, OD
Dec. 13, 2017
What does the future of optometry look like over the next five years? The question was addressed at “The Future of Optometry,” a presentation at the 2017 Vision Expo West meeting that was sponsored by Essilor.
Mark Wright, OD, FCOVD, and Richard Edlow, OD, presented an analysis of a vast amount of information available from the U.S. Census Bureau, Bureau of Labor Statistics, National Eye Institute, Vision Council surveys, Centers for Medicare and Medicaid, Jobson Optical Group, Vision Watch, AOA Workforce Study, combined with original Jobson research. Panelists Gina Wesley, OD, and Michael Kling, OD, interpreted the data from the perspective of optometrists working daily in the trenches.
The presentation focused on four areas: demand, supply, mega-trends and opportunities. This article focuses on supply for eyecare services and eyewear.
A number of studies have been performed assessing the optometric labor pool, and they consistently reveal an apparent oversupply of doctors (AOA Workforce Study). In spite of that, several new optometric programs were established, further aggravating the situation. Regardless of this apparent disequilibrium, the future for optometric practitioners is extremely positive and full of opportunity.
Build Medical Eyecare Capacity
Decades ago, when one analyzed the labor supply of optometrists in the U.S., it was basically a silo approach. That is, aggregate numbers were captured looking at the routine comprehensive eye exams delivered each year by optometrists and the quantity of optometrists available to deliver the exams. The eyecare delivery system has changed dramatically since then with optometry providing a greater array of services with significant growth in the medical eyecare segment of the industry. It is this segment that should be strategically placed on every optometrist’s radar.
Today, a significant portion of medical eyecare services are provided by both optometry and ophthalmology such that one can no longer take the silo approach of evaluating the optometric labor supply independent of the ophthalmology labor supply. By way of example, for 2015, CMS reports that optometry provided over 11.6 million medically necessary services with allowed charges of $1.2 billion.
Will optometry need to provide a greater portion of medical eye services going forward? To answer that, we must look at anticipated demand for services and the projected supply of both optometrists and ophthalmologists.
What the Numbers Tell Us
Based on historical utilization data and U.S. Census estimates, we are able to project the demand for all eyecare services through 2025. Additionally, we can accurately project the labor supply of optometrists and ophthalmologists through 2025 accessing enrollment data from the Association of Schools and Colleges of Optometry (ASCO) and residency positions from the Association of University Professors of Ophthalmology (AUPO).
For example, in 2018 we expect 1,682 new optometrists to enter the profession, while 1,073 will be exiting (primarily retirement and death) for a net increase of 609 doctors. Similarly, we expect 464 new ophthalmologists completing their residency programs with 417 exiting the field for a net increase of 46 doctors. Next, we add another factor to our labor supply data; converting number of doctors to full-time equivalents (FTE). This becomes increasingly relevant as women become a larger, and significant, component of the labor supply. Studies have shown that women in optometry are clinically active at a rate of 91 percent that of male optometrists. Likewise, women physicians typically provide 82 percent of a clinical full-time position. The data from both ASCO and AUPO are provided in a manner to delineate male and female graduates, so we are able to track entering and exiting providers by sex and apply the FTE factors.
The number of FTE ophthalmologists in the entire U.S. will increase by 246 from the end of 2017 to the end of 2025. That is approximately 31 new ophthalmologists per year for the entire country. It is not too difficult to imagine that, say, eight decide to go to California, another eight to Florida, and perhaps six to New York, and maybe another four to Texas, and four to any other rapidly growing area. That would leave one doctor each year for the entire rest of the U.S.!
At the same time, we expect the demand for eyecare services to grow steadily for the U.S. population 64 years and younger at an annual rate of approximately 1 percent. But, more significantly, the demand for medical eyecare services for the 65 and older population will increase at an annual rate of 2.8 percent. Collectively, optometry and ophthalmology will be faced with an increased demand of 2.6 million exams per year. It would be physically impossible to expect 31 ophthalmologists to make a dent in that demand for care. This increased demand does not include increased demand for ophthalmic diagnostic testing or ophthalmic surgery, which would be expected to grow at a similar rate with the aging of the U.S. population.
Action Plan for Optometry
FOCUS ON ESSENTIALS. Continue to provide superior patient-service-oriented comprehensive eyecare and eyewear.
INVEST IN TECHNOLOGY. Acquire the necessary diagnostic testing equipment to properly manage medical eye conditions.
GROW MEDICAL EYECARE. Position the practice to grow the medical eyecare component of the practice to 20-30 percent of revenue.