Every medical practice, no matter what the specialty, sporadically wrestles with the theory of “supply and demand”. Simply put, there has to be enough people working to handle all the needs of the patient population. When that number falls short, the quality of patient care can suffer as a result. Unfortunately, for ophthalmology, the problem isn’t just with practices that do not have enough qualified staff to handle the needs of their patients; the problem may also be too few ophthalmologists. According to AAMC, by 2020, more than 6,000 additional ophthalmologists are necessary to fill the need in this field. Ophthalmology Management seeks to understand the reasons behind this pending shortage of ophthalmologists and offers a few solutions for what ophthalmology practices can do to help ensure the high quality of care their patients are currently receiving.
The Reason for the Shortage
Patient demand is increasing steadily. Baby boomers are entering their mid-sixties. The American population as a whole is aging, and while baby boomers don’t make up the majority, they are making up a greater percentage than ever before. By 2029, it’s estimated that around 20% of the American population will be over the age of sixty-five. Since cataracts, glaucoma, macular degeneration and diabetes are all age-related eye diseases, it is easy to presume that the demand for ophthalmology care in the next two decades will be higher than ever before. In addition to that, Healio estimates that healthcare reform acts can add more than 30 million patients to the ophthalmology patient pool over the next few years.
Technology. Technological advances in ophthalmology are ongoing. The introduction of EHR alone has changed the landscape of almost every medical practice. The addition of new technology always comes with changes to patient schedules, physician templates, clinic workflow, efficiency, protocols and procedures and adds to the amount of time patients may need to spend in the practice. Implants, injections and other technological advances like the ones outlined by Ophthalmology Web offer opportunities for treatments that weren’t possible before, further increasing the number of patients who can potentially be treated by today’s ophthalmology practices.
No one is coming up behind them to replace the ophthalmologists who are nearing retirement age. Even as medical schools grow, the number of graduates from ophthalmology programs has remained at around 420 per year, notes William Rich, III, MD, FACS, medical director of Health Policy for the American Academy of Ophthalmology. Residency slots for ophthalmology are in short supply compared to the increasing need. Funding for these positions is limited and it’s unlikely that any new residency slots at the GME level will be opened up any time soon. Unfortunately, a high percentage of ophthalmologists are nearing retirement age, especially compared to those in other specialty fields who are at the same point in their careers. That means that the existing shortage in the field of ophthalmology is likely to become more of a problem over the next few years than it is already.
Obviously, ophthalmologists are not going to magically materialize to meet patient demands. That means that existing practices are going to have to rise to the challenge in order to meet patient needs. Ophthalmology Management offers several potential solutions for the rising needs within a practice. They are not complete solutions, but they may help improve the quality of patient care and increase the odds that the existing practices will be able to meet demand for as long as possible.
Physician assistants can help fill in the gap. While they can’t perform the same services as an ophthalmologist, physician assistants can be quite helpful in assuming some of the responsibilities – H&Ps for surgical patients as an example. This frees up the ophthalmologist’s time to concentrate on the things that only they can do. Ophthalmology Management also notes that physician assistants have provider numbers under Medicare and Medicaid, so they can do their own billing. A current problem is that physician assistants trained in ophthalmology are in short supply, but a problem that may be easily rectified with more training programs and mentorships.
Team-based care can offer a number of opportunities to reduce the stress on an ophthalmology practice. Dr. Wiggins, MD, MHA, AAO senior secretary for an ophthalmic practice in North Carolina, recommends increasing the relationship between optometrists and ophthalmologists. In his practice, they use the combined skills of technicians, optometrists, and orthoptists to provide the best possible level of patient care. Instead of segregating patient care so that each team member deals with all the issues related to a single patient, he combines their expertise so that each team member is able to focus on their specialties. According to Dr. Wiggins, ophthalmologists will need to shift their focus to becoming managers of care rather than merely the ones who provide it.
Consolidation also helps with a number of other potential issues, including, as Medscape points out, the office management portion of the practice. By consolidating practices, doctors can afford to hire more specialized, competent office managers and other professionals to oversee the business side of the practice while they focus on the important aspects of patient care. Ophthalmology Times agrees wholeheartedly that the trend toward consolidation will benefit both ophthalmologists and the optometrists who choose to practice with them, as those optometrists will likely benefit from a higher pay scale than those in solo practices.
Technology. While improvements in technology have created a higher demand for ophthalmologists, technology can also provide faster options for treatment that require less hands-on time from an individual ophthalmologist. Remote care and telehealth options will enable ophthalmologists to treat some conditions without ever leaving their offices, which will also help improve treatment over time.
There are many problems facing the field of ophthalmology over the next several years. The manpower shortage isn’t going to get any better, but there are solutions.
Contact us for more information about creating patient management practices that are streamlined to help better manage an ophthalmologist’s time.