Workforce Predictions in Optometry: Seeing Into the Future?

Christina M. Sorenson, OD


February 17, 2015

Editor's Note: The American Optometric Association and the Association of Schools and Colleges of Optometry commissioned the Lewin Group to conduct the National Eye Care Workforce Survey of Optometrists in 2012. The goal was to develop a model to predict future changes in the supply and demand of eye care. The results were recently released in two parts: the survey of optometrists[1] and the workforce supply-and-demand projections.[2] A previous commentary reviewed the findings of part 1, the survey of optometrists, survey.

The survey of optometrists assessed the current state of practice in optometry, including number of days worked, office locations, and whether optometrists were in a group practice or self-employed. The results revealed that most optometrists practice about 40 hours each week, take 5 weeks of vacation each year, are employed as younger optometrists, and maintain an excess availability of just under 20 patient slots each week. One interpretation of the study also might lead us to conclude that the future workforce will be made up primarily of Asian women who work just under 40 hours each week.

The second part of the study was a projected analysis of the supply and demand of the eye care provider workforce—optometry and ophthalmology—over the next decade.

The supply-and-demand model was developed with the idea of being able to modify the results as new insights are clarified. Although I generally don't care for the shoulder-shrug phrase of "It is what it is," it is very applicable to this part of the study. The results are equivocal as published, even with the ability to later modify the results.

There are too many limitations to the model and too many current variables that were not even considered in the study. On the supply side, the model makes use of the number of graduates from optometric institutions and ophthalmology training programs, retirement data, and mortality data. On the demand side of the equation, the model uses the 2010 census, current utilization rate of eye care services, and its own study of the optometric workforce.

So, what were the results? There will either be an excess of approximately 9000 full-time eye care providers or a deficiency of 4300 full-time eye care providers. Tight predictions, right? I know my crystal ball is no better; hence, "It is what it is."

Some of the interesting assumptions have already been proven to be incorrect, such as the number of new optometric programs and the size of current programs. We have surpassed the 2012 estimate by three probable programs.

Other assumptions were not even considered—for example, the looming diabetes epidemic.

Furthermore, current utilization of optometric services did not include vision-only insurance plans, still the most common form of optometric reimbursement.

Moreover, there was no look at remote medicine. It's available in a number of locations, where all patients with diabetes now receive a fundus photograph that is taken by a technician and then sent to a remote reader—and just like that, an annual diabetic examination is completed, without a visit to an optometrist or an ophthalmologist. This service is very fast, very easy, and very cost-effective, and it alone could significantly reduce the demand on eye care providers. How might technology or paraprofessional utilization even impact the eye care visit?

Another area completely ignored is the utilization of the Affordable Care Act (ACA). Given the political climate that awaits us in 2015, the ACA might be systematically dismantled by the Republican Party in its next session. How might this affect the use of optometric services?

As always, unknowns vex predictive outcomes, but why were the known influences not included? While I appreciate the amount of work that went into the design of the projections, I look forward to the reworked outcomes as more data come to light.


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