When I started practicing pediatric ophthalmology at Wills Eye Hospital after my fellowship in 1981, the landscape of strabismus care in Philadelphia and other urban settings was very different. At that time, there were relatively few pediatric ophthalmologists, and many general ophthalmologists were still performing strabismus surgery. As the number of pediatric ophthalmologists grew, the number of strabismus cases performed by general ophthalmologists dwindled. Today the number of pediatric ophthalmologists practicing in the United States has increased exponentially, but the geographic distribution of specialists continues to be a major problem for providing pediatric ophthalmology care. In this issue, Bernstein and I explore some of the other problems the specialty is encountering.
There are fewer applicants for pediatric ophthalmology fellowships and an increased number of international medical graduates who will return to their native countries after fellowship training. Opportunities such as early surgical exposure to strabismus and increased mentorship in residency have not persuaded more residents to apply for pediatric ophthalmology fellowships.
Reimbursement issues have not been addressed by insurance companies or the government, and strabismus surgery continues to be among the lowest paid ophthalmology procedures. Many pediatric ophthalmologists supplement their practice by performing procedures such as plastic surgery, skin care, and general ophthalmology. Some pediatric ophthalmologists have retired early because of the difficulty of making a living.
If these issues are not addressed, they will substantially reduce the number of full-time practicing pediatric ophthalmologists in the United States. I believe that the American Association for Pediatric Ophthalmology and Strabismus should take a larger role in resolving these issues, otherwise a potential crisis in pediatric ophthalmology may become a reality.
Leonard B. Nelson, MD, MBA