Abstract
Purpose :
States can expand scope of practice (SOP) laws in an attempt to attract additional providers. To our knowledge, the effectiveness of this strategy has not been evaluated in the field of optometry. We analyzed the relationship between SOP expansion and changes in optometry workforce density in the U.S. using publicly available population health databases.
Methods :
Our analytic approach brings together several different data sources. We calculated the per capita number of optometrists per state between 2010-2021 through Bureau of Labor and Statistics (BLS) and U.S. Census data. We collected changes in state SOP laws by searching state legislative websites and analyzing enacted legislation and regulations across 50 states and the District of Columbia. An SOP change was defined as expanding optometrists’ scope of practice to include injections, “lump and bump” removal, and/or laser procedures. Using an interruptive time serious model, we controlled for various socio-economic and population health characteristics, including age, income, and rates of vision difficulty, diabetes, poverty, and uninsured status.
Results :
Preliminary analysis of aggregated data from all states showed that the number of optometrists per 100,000 people before an SOP expansion was 11.4 (SD 3.7), and it was also 11.4 (4.2) after expansion. In the subgroup (n=13) that enacted a policy change between 2008-2019 (shifting forward the time period of interest 2 years to allow for a lag time of potential effects), these numbers were 10.3 (5.4) per 100,000 before expansion and 11.6 (4.6) after. When controlling for socio-economic and population health characteristics, modeling of both nationwide data and the 13-state subgroup revealed SOP expansion correlated with an insignificant decrease in workforce density of 0.23 (CI -1.36 – 0.91) and 0.08 (CI -1.39 – 1.23) per 100,000, respectively.
Conclusions :
Our population-level data suggest that in the U.S., legislation expanding optometry scope of practice has not been associated with an increased workforce density. These findings can inform state legislators in their efforts to balance access to eyecare with patient safety.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.