Inadequate number of ophthalmologic clinicians predicted by 2035

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Sean Berkowitz, MD, MBA, reported that a “sizable shortage of ophthalmology supply relative to demand by the year 2035” is expected based on the data from the Department of Health and Human Services, Health Resources and Services Administration (HRSA).¹ Berkowitz is from Vanderbilt University Medical Center, Department of Ophthalmology, Nashville.

The investigators explained that the findings about supply and demand for the ophthalmologic workforce have varied since the 1980s.²

“At the time,” they said, “there was concern for physician surplus. As a result, in the 1990s, the American Academy of Ophthalmology commissioned the RAND Corporation to evaluate the eye care workforce supply requirements, which found a significant excess of eye care providers relative to public health need and demand; however, the findings were dependent on model assumptions in work-time ratio of ophthalmologists and optometrists.”³

In the early 2000s, the aging of the Baby Boomer generation was expected to result in “significant growth in demand for surgical services,” with ophthalmology being impacted the most because of the need for cataract surgeries.⁴

This demand was compounded by the drop in the number of ophthalmologists in relation to the population, which decreased from 6.30 to 5.68 ophthalmologists per 100,000 from 1995 to 2017. There was also an increased ratio of older to younger ophthalmologists,⁵ Berkowitz and colleagues pointed out.

Over the last 10 years, the percentages of the annual turnover of the ophthalmology workforce have ranged from 3.7% to 19.4%, with about a third of physicians separating from at least 1 practice⁶ and a significant increase in the rate of ophthalmology practice consolidation.⁷

Observational cohort study

Based on the previous data, Dr. Berkowitz and colleagues wanted to analyze the ophthalmologic workforce supply/demand projections from 2020 to 2035. They conducted an observational cohort study using data obtained from the HRSA’s National Center for Health Workforce Analysis using the Health Workforce Simulation Model (HWSM), a microsimulation model. The main outcome was the projected workforce adequacy over time.

The investigators reported, “From 2020 to 2035, the total ophthalmology supply is projected to decrease by 2,650 full-time equivalent (FTE) ophthalmologists (12% decline) and total demand is projected to increase by 5,150 FTE ophthalmologists (24% increase), representing a supply and demand mismatch of 30% workforce inadequacy.”

Generally, by 2035, “ophthalmology is projected to have the second worst rate of workforce adequacy (70%) of 38 medical and surgical specialties studied,” the investigators projected.

The analysis showed a marked difference between rural and urban locations by 2035. “The level of projected adequacy was markedly different based on rurality by year 2035 with 77% workforce adequacy versus 29% workforce adequacy in metro and nonmetro geographies, respectively,” they commented.

The study reached the following conclusion, “The HRSA’s HWSM forecasts a sizeable shortage of ophthalmology supply relative to demand by year 2035, with persistent geographic disparities. These forecasts should be interpreted in the context of a complex meshwork of allied health professionals, a dynamic and aging ophthalmology workforce, and diverse and changing patient population who hopefully will have reduced barriers to accessing eye care. Further dedicated workforce supply and demand research for ophthalmology and other professionals is needed to help inform policy decisions and strategy to overcome projected workforce inadequacy.”

References:

1. Berkowitz ST, Finn AP, Parikh R, Kuriyan AE, Patel S. Ophthalmology workforce projections in the United States, 2020 to 2035. Ophthalmology. 2024;131:133-139; doi: https://doi.org/10.1016/j.ophtha.2023.09.018

2. Trobe JD, Kilpatrick KE. Future requirements for and supply of ophthalmologists. What do the forecasts show? Arch Ophthalmol. 1982;100:61-66.

3. Lee PP, Jackson CA, Relles DA. Estimating eye care workforce supply and requirements. Ophthalmology. 1995;102(discussion 1971-1972):1964-1971.

4. Etzioni DA, Liu JH, Maggard MA, Ko CY. The aging population and its impact on the surgery workforce. Ann Surg. 2003;238:170-177.

5. Feng PW, Ahluwalia A, Feng H, Adelman RA. National trends in the United States eye care workforce from 1995 to 2017. Am J Ophthalmol. 2020;218:128-135.

6. Patel PN, Patel PA, Sheth AH, et al. Ophthalmologist turnover in the United States: analysis of workforce changes from 2014 through 2021. Ophthalmology. 2023;130:973-981.

7. Smith JF, Hintze BC, Anderson ST, et al. Trends in ophthalmology practice consolidation: 2015-2022. Ophthalmology. 2023;130:983-992.