Abstract
Purpose :
The rising burden of ophthalmic conditions necessitates access to specialized care for a geographically diverse population. The purpose of our cross-sectional study was to assess the geographic distribution of ophthalmic surgeons performing subspecialized surgeries and factors associated with practicing in a rural area.
Methods :
We identified patients ≥65 years old who underwent a subspecialized ophthalmologic surgery between 2012-2022 using current procedural terminology (CPT) codes among 100% Medicare Fee-for-Service claims. Surgeon’s subspecialty was identified via CPT code if they performed at least one of the following subspecialty surgeries: cornea: corneal transplant; glaucoma: trabeculectomy, aqueous shunt implant; oculoplastic: eyelid procedure, lacrimal gland procedure, enucleation, externation, orbitotomy, ocular implant procedure; retina: repair of retinal detachment, pars plana vitrectomy; and strabismus: strabismus surgery. Students t test and χ2 test were used for categorical and continuous variables, respectively. A multivariable logistic regression analysis was used to assess surgeon characteristics associated with practicing in a rural area.
Results :
Among 15,484 ophthalmologists, 2,334 (15.1%) performed corneal transplants, 2,908 (18.8%) performed glaucoma surgery, 5,277 (34.1%) performed oculoplastic surgery, 3,917 (25.3%) performed retina surgery, and 1,048 (6.8%) performed strabismus surgery. A higher proportion of patients for cornea (patients = 35,700; 18.2%; surgeons = 84; 3.6%), glaucoma (patients=42,306; 15.4%; surgeons=132; 4.54%), oculoplastic (patients = 111,144; 17.6%; surgeons = 670; 12.7%), retina (patients = 199,755; 19.7%; surgeons = 165; 4.2%), and strabismus (patients = 8,676; 17.4%; surgeons = 25; 2.4%) resided in rural areas relative to surgeons (p<0.0001). On multivariable analysis, female surgeons (OR: 0.68; 95% CI: 0.56-0.82 vs males) and recent graduates relative to those who graduated 11-20 years (OR: 1.4; 95% CI: 1.08-1.82) or 21-30 years (OR: 1.66; 95% CI: 1.28-2.15) ago were less likely to practice rurally.
Conclusions :
There are fewer ophthalmic surgeons in the rural US relative to patients for all subspecialties. Odds of practicing in a rural area varied by surgeon sex and years since graduation. Our findings highlight the rural-urban workforce discrepancy and require further exploration.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.