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2010: AN Optometric Odyssey, Episode XIWorkforce: Will There Be Too Many O.D.s by 2010?The scale can tip either way. It's a function of supply and demand.Judith Lee, Senior Contributing Editor You've said it, and you've heard your colleagues say it: There are just too damn many optometrists. It helps the chains and hurts private practice. It strengthens managed care and weakens doctors. If the schools keep cranking out docs at this rate, you won't be able to make a decent living. Well, yes, no and maybe so. Over the past 3 years, the AOA studied the supply of and demand for optometrists, projecting the numbers out over the next 30 years. Today, you have about 32,500 colleagues-an estimated oversupply of about 850. By 2010, the ranks will swell to about 39,000-about 3,700 of whom won't have enough to do if existing models hold. These numbers come from the AOA-commissioned "Workforce Study of Optometrists," compiled by the Boston consultancy of Abt Associates Inc. and released earlier this year. Yet, plenty of things may happen over the next 10-30 years that can balance the scales. Managed care could drive more patients into optometric offices. Changing work habits could make many doctors go part-time. Rising computer use could sharply drive demand. Ditto for heightening public awareness of eye exams for infants, schoolchildren and adult drivers. This 11th installment of our yearlong series, "2010: An Optometric Odyssey," will explain what it all means. The Big "If" The Workforce Study projects that in 2010 there will be too many optometrists. The oversupply will increase through to 2015, and then gradually decline over the next 15 years. Some regions will have a larger oversupply than others. If you practice in the Midwest, for example, get ready to feel it the most. At this point there's little the profession can do to avert oversupply. Most of it will come from the large number of O.D.s already in practice vs. the small number of O.D.s who will retire in the next 10-15 years.  Still, national and state optometric leaders are singularly upbeat about the future size of the workforce. The AOA projects that demand for vision services will grow in the coming decades, thanks to an aging population and the influence of managed care. These leaders say changes in the profession and the way you deliver care bodes well for optometry in the 21st century. "We need to play on the strengths of the profession, and these are many," says AOA Workforce Project Team chair Anthony DiStefano, O.D., M.P.H. "We shouldn't let the 'numbers game' cloud this very positive time for the profession." So, if the demand for eye and vision care increases as the AOA projects, oversupply won't be an issue. In fact, you may face the opposite problem (or blessing, depending on your perspective). A 1% increase in demand for eye exams would eliminate the oversupply and result in a shortage of optometrists by 2013. Of course, the AOA study is based on some assumptions. "If you don't agree with these assumptions, or if the assumptions turn out to be wrong, then the whole thing goes out the window," says Irving Bennett, O.D., who served on the AOA Workforce Project Team. But Dr. Bennett believes these projections will hold. Exploring New Frontiers Many factors portend a rise in demand by 2010, Dr. Bennett says. The population is getting older. The Census Bureau projects that another 14 million Americans will join the ranks of the 40-and-over group. About 70 million Americans use computers at work, the Bureau of Labor Statistics reports. And 140 million use the Internet. Surveys indicate that 80% of computer users experience eyestrain. Then, there are the 16.3 million children under age 5 who haven't received eye exams. "If you really get the population to seek proper eye care, you end up with not enough optometrists," Dr. Bennett says.  The Workforce Study notes that two groups are clearly underserved by optometrists: patients younger than 19 and over 65. With optometry's expanded scope of practice, it's only a matter of time until more of these patients seek care from O.D.s. "Optometry's move into therapeutics will cause an evolution toward more optometric care for both these groups," says Harvey Hanlen, O.D., former AOA president under whom the study was released. "For instance, in just the past few years, there's been a 126% increase in the number of glaucoma patients seeing optometrists." Still, the profession must work harder to drive demand. "We must take advantage of the legitimate, unmet need out there; we will have to go after it," says Craig Neilsen, O.D., Connecticut Optometric Association president. Shifting Demographic The demographics of the doctors who provide care are changing, and this will affect supply and demand. More women are joining the profession. Two of every five O.D.s under 40 are women vs. one of every 10 over 40. In 1995, more women than men graduated from schools and colleges of optometry. Another key element is the number retiring from the profession vs. those entering it. The AOA projects about 550 O.D.s will retire each year until 2004, gradually rising to 820 a year by 2015.  The problem is, more graduates will join the profession-about 1,125 each year. By 2010, there will be 38,000 O.D.s in practice, about 23% more than there are today. Limiting the number of graduates won't help; most of these doctors are already in practice and "in the pipeline," or school. "Many of our alumni feel there is too much competition out there," says Thomas Lewis, O.D., Ph.D., president of Pennsylvania College of Optometry. He says these doctors typically graduated 20 years ago or more. More recent graduates don't always share this sentiment. "Those who graduated in the past 15 years don't feel as dissatisfied; managed care is all they know," Dr. Lewis explains. It creates a challenge for the schools and colleges of optometry. "I don't think anyone in the colleges is thinking about increasing enrollment, but we should be concerned about a decline," Dr. Lewis says. "We don't need more optometrists, but we do need to maintain the high quality of students who come into this field." The AOA study notes that a decline in income is a "classic sign" of oversupply. Review of Optometry has conducted an income survey every year for the past 14 years. It shows that O.D. incomes have continued to rise-even in the past 2 years as practitioners struggled with managed care. This year, income was up 6.5% vs. last year (see our income survey, Can You Keep the Bang Going?). Regional Variations With all the good news about income, what's the beef about oversupply? The Workforce Study points out that the oversupply is more acute in some regions than others. For example, the Northeast has an oversupply of fewer than 100 O.D.s today, growing to almost 500 by 2010. In other regions:
Regional differences account for some dissatisfaction, but you can't ignore national trends. The biggest is managed care. The Workforce Study finds that managed-care patients are about 10% more likely to seek optometric care than are patients with other types of insurance. Even though this may mean less revenue per patient, the exposure of optometry's capabilities to a wider population can only mean growth for the profession. Driving Demand The future trends in the optometric workforce clearly point to a challenge for optometry: increasing the demand for vision care. "For the next 25 years, the challenge is to expand the demand for optometric services," Dr. DiStefano says. "There is a large amount of unmet need in our society, and this public health need is easy to support." One example is Kentucky's new law that requires all children to have an eye examination before entering school. Parents have until January 2001 to comply, but Kentucky O.D.s are already feeling an increase in their pediatric patient load. (See "Kentucky Kids Must Get Eye Exams," News Review, September 2000.) "Our office has not been overrun with new patients, but there has been a healthy boost," notes James Sawyer, O.D., president of the Kentucky Optometric Association. There are 52,000 children born in Kentucky each year, and the law applies to 90 percent of them. Kentucky eye doctors are accommodating the increased demand. "Our members have offered to add hours in the evenings or weekends to become more family-friendly," says KOA Executive Director Darlene Eakin. Dr. DiStefano points out that, while raising public awareness of the need for eye care may seem a daunting challenge to state and national optometric groups, it deserves the same kind of support and energy that optometrists put into passing therapeutic laws. At least three other efforts are under way that could drive demand for optometric care:
"This is the kind of aggressive expansion we need," Dr. DiStefano says. "It deserves the same intensity and creativity that we invested into expanding the scope of practice." Of course, increasing demand for care isn't the only way to respond to an optometric oversupply. Individual doctors may take action, too, in how they choose to practice. Some may do this by practicing part-time, or on nights and weekends. Others might respond by relocating from regions with too many O.D.s to areas that don't have enough. Some things may never change the perception that there are too many O.D.s. For some, any competition will always be too much. For everyone else, public awareness and reaching out to underserved groups is critical to driving demand. The proof will be in the balance sheet. Doctors pleased with their incomes won't gripe about the number of practitioners. For those who want more, it will be a different story. |
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