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Paula Wu, Hao Feng, Ron A Adelman; Longitudinal trends in the eye care workforce over two decades. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5088.
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© ARVO (1962-2015); The Authors (2016-present)
A shortage in the eye care workforce has been projected. Better understanding the eye care workforce distribution nationwide will aid in developing effective interventions. Our objectives were: 1) To study longitudinal changes in the density of ophthalmologists and optometrists at the county-level; 2) to evaluate how the ophthalmology workforce is aging; 3) to study county characteristics associated with ophthalmologist density.
We performed a retrospective study of all ophthalmologists from 1995-2013 and optometrists from 1990-2013 in the United States using the Area Health Resource File. The number of eye care providers per 100,000 individuals in each county, ratio of number of ophthalmologists under 55 years old to 55 years or older; univariate and multivariate logistic regression analysis of county characteristics predicting the availability of an ophthalmologist were assessed.
From 1995-2013, the national ophthalmologist density decreased by an estimated 0.67% per year. In 2013, counties had a mean of 5.8 ophthalmologists per 100,000 individuals, down from 6.3 in 1995 while the general population was increasing. In total, 62% of counties lacked any ophthalmologists. Ophthalmologists were three times more likely to practice in metropolitan over non-metropolitan or rural counties. Ophthalmologists under 55 years of age (“younger” practitioners) were 40% more likely to be found in metropolitan areas compared to those 55 or older (“older” practitioners). Rural counties had the smallest estimated annual percent increase in older ophthalmologists (2.16%) but the greatest estimated annual percent decrease in younger practitioners (-1.78%). Ophthalmologists were less likely to be found in counties with low existing healthcare infrastructure and counties economically dependent on farming. Optometrist density increased dramatically over the last several decades. Nationwide, there were 14.9 optometrists per 100,000 individuals in 2013, up from 11.1 in 1990. In total, 24% of counties lack an optometrist.
Rural counties have high rates of out-migration of both younger and older ophthalmologists. New ophthalmologist supply has not met population growth over the last several decades. Optometrist supply has increased dramatically. Rural counties still have a disproportionally lower supply of all eye care providers.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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