A Boom's Downside
Dr Patel said that in her practice, this patient boom is so far being managed with the efficient use of electronic medical records and medical scribes. However, the trend toward increased volume may soon strain even high-functioning practices, as an already precarious patient/caregiver ratio falls ever more out of balance.
It has been estimated that for the approximately 450 new ophthalmology residents graduating every year, 550 established ophthalmologists will retire.[1] This problem is compounded when one considers that the percentage of seniors in this country is estimated to grow 3% annually, in comparison with a 0%-1% growth rate for ophthalmologists.[1]
Although labor shortages will probably give young ophthalmologists greater negotiating power, it will also come with an expectation of increased output. Even today, we see the deleterious effects that this can have on working ophthalmologists. Results from the 2016 Medscape Ophthalmologist Compensation Report found that doctors in this field ranked nearly last (23out of 26 specialties) in feeling fairly compensated, and also had a decline in metrics of satisfaction when asked whether they would choose the same specialty or practice setting again if given the choice (Table).
Table. If You Had to Do It All Over...
| 2016 Report | 2011 Report | |
|---|---|---|
| I would choose medicine as a career | 56% | 66% |
| I would choose the same specialty | 55% | 79% |
| I would choose the same practice setting | 27% | 54% |
The source of this encroaching malaise appears clear and consistent with other specialties: a death-by-a-thousand-cuts effect from mounting administrative burdens and patient hours. Asked to rank the main causes of burnout in their field, respondents to the Medscape Ophthalmology Lifestyle Report 2016 listed "too many bureaucratic tasks," "increasing computerization of practice," and "impact of the ACA" as their top 3 choices, with criticisms about increasing work hours and an abundance of daily patient appointments following closely thereafter.
For Dr Rapuano, there is probably a generational divide at play in the data surrounding physician dissatisfaction.
"When I was still in med school, I was sold a story that ophthalmology was a certain level of work and income. That is rather different than the reality when I got into practice in 1991 and reimbursements started being cut dramatically," he said. "My guess is the older generation is probably less satisfied because they knew the way it was before and they benefited from it."
It's an assessment that Dr Patel, who finished her fellowship in 2010, agrees with: "Now in residencies, they're seeing a certain volume of patients and kind of know what a busy day is going to be like, as opposed to 10 years ago, when it wasn't as busy," she said. "My sister is an ophthalmology resident right now, and I know what volume she's seeing. I don't think she'll be surprised at all at getting into practice where they say, 'You'll have to see 50 patients a day,' because that's what she's seeing already."
Dr Rapuano added that he believes another clear contributor to dissatisfaction is decreasing reimbursements making it harder to recoup initial investments in the high-priced technology upon which the field is ever more dependent.
Still, as raw data tend to do, there are elements that complicate the narrative of all-around dissatisfaction, with findings from the Medscape Ophthalmology Lifestyle Report 2016 indicating that doctors in this field ranked second among all polled specialties for happiness at work and eighth for happiness outside of work. However, these metrics also showed a downward trend from 2 years prior.
Medscape Business of Medicine © 2016 WebMD, LLC
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Eye to the Future: Predicting 2017's Ophthalmology Compensation Trends - Medscape - Dec 23, 2016.
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