The optometric manpower study

The profession has long awaited the release of the Eye Care Workforce Study. The project was jointly commissioned by the American Optometric Association (AOA) and the Association of Schools and Colleges of Optometry (ASCO) and was conducted by the Lewin Group. The date of the study is listed on the Executive Summary as April 25, 2014, and the results were made public June 10. Congratulations to the AOA and ASCO for commissioning the study. The last one by Abt was in 1999, so this was quite timely and in fact long overdue.         

I learned a lot from the executive summary. First, the estimate of optometrists providing direct patient care in the U.S. was 39,580 in 2012. The makeup of the optometric workforce at present is 60 percent male, 40 percent female. That number will skew toward more women in the optometric workforce over the next decade as more female optometry students enter practice. Of course, there was the age breakdown as well-the average age of male ODs was 51 years, women 40 years. Another number I found interesting: for the purpose of the study, one ophthalmologist full-time equivalent (FTE) is equal to 1.36 optometrist FTE.¹ Ophthalmologists generally see more patients in a day than we do, so that estimate may be a little low.           

According to the study, there appears to be an “adequate” supply of eye doctors, optometrists and ophthalmologists (the latter new to this study), including projections of new doctors, to meet current and projected demand for eyecare services through 2025.² Yet the report makes some assumptions that bolster the projections, and if some of those assumptions don’t come to pass, then the projections can fall apart rather quickly.

Consider the following factors:

• Optometric supply. “Supply changes over time as a result of attrition from the workforce, as older optometrists and ophthalmologists leave the workforce through retirement or death.”¹ While no exact number is attributed to this supply change, this impact may not be great. From the study, the average age of male ODs is a little shy of 51. In 10 years that becomes 61. I don’t know of many folks who retire at 61, nor do I know many optometrists who have retired before 70. The OD at the Georgia practice I acquired in 1991 was 77 at the time, and he continued to practice for several years after that. One of the great aspects of optometry is that an optometrist, assuming his or her health holds out, can continue to practice well beyond the normal retirement age of 65. It is one of the reasons I chose this profession. I don’t think attrition is going to be a major factor in reducing optometric supply.

•  Affordable Care Act (ACA) The study assumes an increase in children’s eyecare visits as a covered service and an increase in medically related adult office visits under the ACA. The study does assign numbers to each category, but my concern is this: what if the entire Act disappears? The ACA has been a very contentious topic seemingly from its conception, and poll numbers show the majority of Americans are unhappy with the law.³ What if the political winds change, and some or all of the ACA is repealed? The numbers would definitely skew should that happen. 

•  Increase in diabetic medical office visits. The study likewise assumes an increase in demand for medical eye care due to the increasing number of diabetics in the U.S. population. While it is a sad fact that diabetes is on the rise in the U.S., with an estimated 30 million people suffering from the condition or living unaware they have it,⁴ the increase in the number of diabetics does not necessarily directly correlate to an increased demand. How many diabetics come to your office routinely every year for their dilated fundus exams? For that matter, how many medical doctors recommend yearly eye exams for their diabetic patients? While there are many inroads for optometric expansion, and systemic-related ocular care is a large one, much public health education needs to take place to ensure diabetics seek and receive the necessary yearly eye health care.

• Increase in overall efficiency of existing optometric supply base. If the executive summary of the study makes one point clear, it is that projected demand can be handled with an increase in optometric efficiency. The study indicated that a survey of current practitioners felt they could handle a 32 percent increase in patient visits without affecting their current structure. The average optometrist sees 1.1 patients per OD-hour.⁵ The projected increase in efficiency more than covers the projected potential demand from baseline, an increase in potential visits due to the ACA, and a potential increase in diabetic office visits. The executive summary states plainly: “If we take this excess capacity into account and compare supply including excess capacity to the baseline demand (i.e., the normal aging of the population), there is no longer excess demand. In fact, our estimates indicate that there is significant excess supply when this excess capacity is included and, though it declines modestly over the forecast period, it remains substantial at about 9100 FTE by 2020…if the sources of demand are realized (ACA and diabetes), then excess capacity in the workforce will be substantially reduced, but not eliminated.”⁶ (Emphasis added)

Any study trying to forecast the future obviously has to make predictions and assumptions, and the Lewin Group has done an admirable job in this report. Not sure Occam’s razor applies here-things aren’t that simple. The study points out without doubt that optometric (and ophthalmologic) manpower projections can handle any demand, so there is no need for nurses and PAs to delve into eye care. Likewise there is no need for online refractions. There will be more than enough optometrists to handle any eye care need.

While the conclusions of the report were enlightening, they are based on a computer model that can be modified as conditions change. Yet a computer model does little for the optometrists bending their backs every day in the exam lanes trying to pay the bills and make a living in an ever-increasing, hypercompetitive environment. While the current model suggests the current level of optometric manpower may be “adequate,” a change in circumstances might throw the model awry, in which case practicing ODs won’t be looking for Occam’s razor, but a straight one.

References

1. The Lewin Group. Eye Care Workforce Study: Supply and Demand Projections. Executive Summary. April 25, 2014, page 6.

AOA Week in Focus, June 12, 2014. Available at: http://www.aoa.org/news/inside-optometry/study-finds-eye-care-workforce-is-adequate-to-meet-projected-demand?sso=y.

2. CNN Poll: Health care law support drops to all-time low. December 23. 2013. Available at: http://politicalticker.blogs.cnn.com/2013/12/23/cnn-poll-heath-care-law-support-drops-to-all-time-low/. Accessed June 2, 2014.

3. Stobbe M. Diabetes in America continues to increase. Available at: http://www.jems.com/index.php?q=article/news/diabetes-america-continues-increase.

4. Management and Business Academy. Key metrics: Assessing optometric practice performance, p. 7. Available at: http://www.mba-ce.com/data/sites/1/paa_keymetrics_0813.pdf.

5. The Lewin Group. Eye Care Workforce Study: Supply and Demand Projections. Executive Summary. April 25, 2014, page 12.