Like every optometrist, we were educated to be generalists. Yet, by both residency training and career choice, our expertise has deepened in a narrow area of eye care to where neither of us has performed in many years the defining skill of our profession – refracting and providing an eyeglass prescription.
As specialists in a primary care profession, we can’t help but wonder: What exactly is optometry in 2019? More importantly, given the future health care needs of society and the trends in how that care is likely to be delivered, what role – or more accurately, roles - do we want our profession to play? What would that look like? How do we get there?
In this entry in our blog, we hope you will indulge us to take stock, be a bit audacious and imagine a vision for the future.
As optometrists in a surgical and medical referral center, we have a perspective on our profession that’s different than if we practiced primary eye care. From this position, we think this could be a golden moment to secure the future of optometry. But we as a profession need to design and take control how we get there.
Demand and supply
We’ve all heard how the aging baby boomers will soon stress our nation’s health care system. If you aren’t yet a believer, consider these statistics that cause the American College of Surgeons to label this “an emerging crisis”:
- The U.S. population is projected to increase 17% between 2001 and 2020. The demand for eye health care services is expected to increase 47% (HHS).
- Between 2002 and 2030, the number of people age 65 and older in the U.S. will double to nearly 70 million (U.S. Census Bureau).
Importantly, these projections don’t include the millions of lives added to the health care roles because of the Affordable Care Act.
Here is an important fact for optometry: The aging population won’t significantly increase the demand for refractive care, but it will greatly increase the demand for eye disease treatment. In just the 7 years between 2013 and 2020, there will be 15 million new patients with vision-threatening conditions (Klein et al.). Those numbers will increase significantly more in the future.
Here is some additional interesting information:
- The number of ophthalmology residents enrolled in teaching programs in the U.S. has been steady at about 450 per year for a long time and is not likely to change (Association of University Professors of Ophthalmology).
- If nothing changes, retina specialists may have to double their productivity despite the fact that many already see upwards of 60 to 70 patients per day. How is that even possible?
The bottom line is this: ophthalmologists alone can’t care for the future explosion of patients with eye disease. They can’t even take care of it all now. And they know it.
Ophthalmology proposes collaboration
Several years back, Harvey Feinberg, MD gave a frank keynote address to a skeptical, even resistant, audience: the members of the American Academy of Ophthalmology. His message? Ophthalmology will need to work with optometry to meet this demand.
In response to Dr. Feinberg’s pointed call to action, the AAO created its Task Force on Eye Care Delivery for the purpose of designing and promoting collaborative care models with other health care professionals, including optometrists. In addition, the American Society of Cataract and Refractive Surgeons created the Integrated Ophthalmic-Managed Eyecare Delivery program to promote a limited form of OD-MD collaboration it calls integrated eye care.
There is good reason to view these initiatives with promise and caution. One ophthalmologist noted a benefit of this kind of collaboration is that, “it enables ophthalmologists to establish scope-of-care boundaries.” Still, while there may be significant differences between the vision of collaboration of optometry and ophthalmology, especially regarding professional autonomy, dialogue can promote interprofessional trust.