Ophthalmology: Small specialty, high demand

Recently, I attended my first meeting of the American Academy of Ophthalmology (AAO). According to one of the planners, there were about 25,000 attendees in total, about 17,000 of whom were from the United States.

From that standpoint, academy was a humbling experience. Because we have such specialized knowledge, ophthalmologists are used to feeling needed-but there seemed to be an endless supply of other ophthalmologists with more knowledge and experience.

Moreover, we need to increase ophthalmic capacity to deal with the aging American population.³ Upstream changes are already occurring-the Association of American Medical Colleges set a goal of increasing MD supply by 30% by 2016, and enrollment has since increased.^4,5 However, residency programs have to grow as well, and there will be only 30 more ophthalmology residency graduates this year compared with 2001.⁶

In the future, we may consider shortening training as well-many other countries combine aspects of undergraduate and medical school education. In the 1970s, almost one-fourth of American medical schools established a 3-year curriculum, but these were all discontinued. In Canada, a couple programs still exist, and longitudinal data have not shown significant differences between these graduates and those from 4-year programs.⁷

Other possible solutions to a physician shortage include delegating work to non-physicians or boosting the productivity of existing doctors. For patient safety issues, there are many things that ophthalmologists, as eye surgeons, cannot delegate to non-physicians. The challenge that we will face is to see all of these extra patients equally carefully yet more efficiently.

Looking back at my own training, I began residency in July 2008 and was seeing four to six patients a day in my weekly resident continuity clinic. By the middle of first year, we were up to 12 to 16 patients a day and started to use technicians. As a second-year resident, I now can have 25 scheduled patients plus two walk-ins, and for third-year residents, the template can go well over 30 patients.

There undoubtedly is a number of visits beyond which resident learning might be compromised, but our current scheduling still lets me spend ample time on the hardest and most educational cases-for whatever reason, I tend to attract panuveitis walk-ins. At the same time, seeing a greater volume of patients increases our learning opportunities, generates more surgical cases, and makes handling routine issues easier.

I may have been just one person out of 25,000 at the AAO meeting, but I take comfort in knowing that each of us is going to be necessary-and very busy-in the future.

References

1. Bureau of Labor Statistics. Employment by industry, occupation, and percent distribution, 2008 and projected 2018. 29-160 Physicians and Surgeons. 2008.

2. The American Board of Ophthalmology. Board certification brochure. 2009.

3. Lee PP, Hoskins HD, Parke DP. Access to care: Eye care provider workforce considerations in 2020. Arch Ophthal. 2007;125:406–410.

4. Association of American Medical Colleges. AAMC Statement on the Physician Workforce. 2006.

5. Association of American Medical Colleges. Medical school enrollment plans: Analysis of the 2007 AAMC Survey. 2008.

6. Accreditation Council for Graduate Medical Education. Number of accredited programs by academic year, http://www.acgme.org/adspublic/reports/accredited_programs.asp?accredited=1

7. Lockyer JM, Violato C, Wright BJ, et al. An analysis of long-term outcomes of the impact of curriculum: A comparison of the three- and four-year medical school curricula. Acad Med. 2009;84:1342–1347.

Bryan Lee, MD, JD, is a second-year resident at the Wilmer Eye Institute. He earned his MD at Washington University in St. Louis and his JD at Harvard Law School.