Workforce projections for optometry.

BACKGROUND: A 1995 workforce study conducted by RAND estimated a large current surplus of eye care providers in the United States. Due to data limitations of the RAND study and the outdated optometric workforce information available, the American Optometric Association contracted with Abt Associates to conduct a study to project future workforce requirements for optometry. METHODS: We collected extensive data on both the supply (work hours, retirement rates, new entrants) and demand (patient encounters and associated time requirements) of optometrists. These data were collected from a survey using stratified random sampling of 1,100 practicing optometrists and were used to develop workforce projections for optometry through the year 2030. Projections were calculated using a forecasting tool that can be used to derive workforce and training requirements under a range of future scenarios. RESULTS: Workforce projections suggest an excess supply of optometrists is likely over the next 20 years. Over the next five years, approximately 550 optometrists are expected to retire each year, while more than 1,100 optometrists enter practice annually. Patient encounter volume is projected to increase steadily, but the effects of this increase are largely offset by an anticipated decrease in optometrist time requirements for routine eye examinations. DISCUSSION: To reduce the size of the anticipated excess supply, optometry may want to focus on ways that demand can be increased. One way to increase demand is through greater convergence between the actual demand for eye care services and the underlying public health need for eye care.     

The Australian optometric workforce 1995

Background : The Australian optometric profession was surveyed to provide updated information on the constitution and activities of the workforce. Methods : A survey form was sent to all registered optometrists in Australia, asking them to provide details about themselves and their professional activities. Statistical information on the Australian population and optometric consultations were obtained from the Australian Bureau of Statistics and the Health Insurance Commission. Results : In mid-1995 there were 2,695 optometrists registered in Australia. Of these, 2,235 were in active clinical practice. This was equivalent to 2,060 full-time optometrists. One-third of active optometrists were female. The average population per equivalent full-time optometrist was 8,950 and the average caseload was 1,271 initial consultations per year. The proportions of female practitioners, part-time practitioners and optometrists who do not provide optical dispensing services have all increased. Conclusions : Although the population per optometrist has fallen since the previous survey, changes in optometric practice and increasing utilisation of optometric services have resulted in slightly increased caseloads, suggesting that the workforce is adequate to meet current demand for optometric eye care. (Clin Exp Optom 1996; 79: 6: 246–254)     

Practice standards for optometry and optometric practice accreditation

Background: To assist optometrists to deliver care more efficiently and effectively, in 1995 Optometrists Association Australia decided to develop standards that would assist optometrists in better managing their practices. Existing practice management standards for health professionals were thought to be either not specific enough for optometric practice or to have shortcomings in the context of optometric practice in Australia. Methods: Following a literature search, material previously developed by Optometrists Association Australia to assist practitioners with management of their practices and standards from other professions were used to assist with the development of a draft set of standards for optometric practices in Australia. Successive drafts were circulated for comment to optometrists in practice, non‐optometrists with experience in the development of practice standards for other health professions and to Australian General Practice Accreditation Limited. The comments were used to refine the standards and the accreditation guidelines to their final form. Results: Optometric Practice Standards suitable for use in a practice accreditation program were developed. The standards comprise seven sections—Practice administration, Quality assurance, Rights and needs of the patient, Practice services, Practice facilities, Communication and Patient records. These sections are divided into criteria that provide the detail of the requirements of the standard. Indicators describing how criteria can be assessed accompany the criteria.     

Symposium on the delivery of optometric care in nontraditional settings. Summary and conclusions

During the 1987 Academy Meeting, a joint Optometric Education/Public Health and Occupational Optometry Symposium was held on The Delivery of Optometric Care in Nontraditional Settings. Papers were presented on prison systems, long-term care facilities, schools for the mental/physically handicapped, home eye care services, migrant work program, and juvenile detention facilities. This paper is an overview of care delivered in nontraditional settings, including important health care and demographic considerations, brief summation of the nontraditional populations presented, the impact on optometric education, and implications for optometric manpower needs.     

New Zealand optometrists 2006: demographics,working arrangements and hours worked

Background: Optometry is a regulated health profession in NZ, with limited student places. With 650 registered optometrists in 2005, the optometrist to population ratio was 1 : 6,291 with no apparent national shortage. If optometrists registered in NZ do not actually live there, a workforce shortage is possible. This paper presents findings from the New Zealand Association of Optometrists 2006 workforce survey of members, which aimed to profile the NZ optometric workforce and to explore factors relating to workforce capacity, job stress and future planning. Methods: A questionnaire was developed to collect information on employment status, hours worked and gender distribution of optometrists in New Zealand. It was circulated to 530 active members of the NZ Association of Optometrists representing 86 per cent of the available optometrists. Direct comparisons with the Australian optometric workforce numbers were also undertaken. Results: Of the 243 respondents, 129 (53 per cent) were male. The median age of all respondents was 39 years (46 for males and 34 for females) and 75 per cent of the respondents were aged younger than 50 years. Fifty per cent had practised 15 years or less. Ten per cent of respondents had ‘time‐out’ during their career and this was significantly more likely for females. Nearly half the respondents were self‐employed (46 per cent) and eight per cent worked as locums. Part‐time employees were more likely to be female and males were more likely to be in full‐time self‐employment. Half the group was under 40 (51 per cent), which accounted for 86 per cent of the full‐time salaried arrangements. Those aged 30 to 39 included 52 per cent of the total part‐time salaried workers. The average working week was 34 hours for women and 39 hours for men; the median was 40 hours for both groups. In the typical working week, 80 per cent of an optometrist's time was spent consulting with patients and five per cent was patient‐related paperwork. The distribution of work arrangements was remarkably similar among New Zealand optometrists, New Zealand GPs and Australian optometrists. In 2006, there were 619 optometrists assessed as working in New Zealand. This equated to 544 EFTOs and a ratio of EFTO to population of 1 : 7,517. Conclusions: The New Zealand optometric workforce in 2006 was sufficient to meet the overall population needs. One‐third of optometrists chose to work part‐time and the proportion of female optometrists has increased over the past 15 years. In the face of expected increasing demand for optometric services, a targeted expansion of the workforce appears desirable.     

Vision care benefits and optometric services in HMOs

General eye care, although not a required basic health service of federally qualified health maintenance organizations (HMOs), is being offered in virtually all HMOs. Reasons for including vision care benefits and optometric services are presented. Data from the Group Health Association of America and the Department of Health and Human Services demonstrates that HMOs are in fact providing vision care benefits and optometric services. The growth of the independent practice association (IPA) model is significant for optometry as it threatens to limit the scope of optometric practice. New professional problems arise as participating optometrists are constrained from performing the full range of optometric services. In recent years optometry has expanded its scope of licensure and practice to incorporate both diagnostic and therapeutic drugs in its management of visual problems. Managed care and alternate delivery systems, however, may restrict the advances that optometry has made in the legislative arena.     

The Australian optometric workforce 2005, analysed by local government areas

Background: Previous studies of the Australian optometric workforce have taken a coarse view of the distribution of optometrists, at best comparing concentrations of optometrists in city and country areas and between states and territories. A more discriminating approach recognising the size and variation in population density of the country is necessary for a more realistic insight into the optometric workforce. This study addresses the distribution of optometrists across smaller geographic units, known as local government areas (LGAs). Methods: The number of equivalent full‐time optometrists in each Australian LGA was determined using data from the Optometrists Association Australia database. Data from the Australian Bureau of Statistics and the Australian national health program (Medicare) were applied to determine the demand for services based on age distributions in LGAs and to calculate the adequacy of the number of optometrists. Results: Optometrists are concentrated in areas of high population with capital city regions and their surrounds well‐serviced but with rural and remote LGAs with low populations generally not having optometrists. The highest excesses of optometrists occur in the capital city LGAs of Melbourne, Sydney and Adelaide (64, 60 and 28.4 equivalent full‐time optometrists respectively). The highest deficits occur in Casey (Victoria), Lake Macquarie (New South Wales) and Onkaparinga (South Australia), (‐16.4, ‐15.6 and ‐13.4 equivalent full‐time optometrists, respectively). Conclusions: There are substantial variations in the distribution of optometrists across LGAs in Australia but the variation is often a poor indicator of the ease with which people can access optometric services. In metropolitan areas, people may live close to an optometric practice in a neighbouring LGA. In rural areas, an LGA may appear to have an adequate number of optometrists but some residents may be several hours from the nearest optometrist or the optometric service is provided on a part‐time basis.     

A comparison of charges by optometrists and ophthalmologists under the Medicare program.

Medicare data obtained from the Health Care Financing Administration was analyzed in relation to average allowed charges by optometrists and ophthalmologists. Optometric charges are considerably lower than ophthalmological charges for all services compared. The policy of different reimbursement levels is currently a major issue being considered by the Physician Payment Review Commission. Optometry must demonstrate that the procedure codes for which they submit Medicare claims are comparable and identical in service content to those provided by ophthalmologists.     

Optometric supply and demand in Australia: 2001–2031

Background: Major influences on health workforce supply include factors such as graduate numbers, retention rates and immigration. This report presents a model of the relationship of the projected Australian optometric workforce and projected optometric service demand for the period 2001 to 2031. Two contrasting hypothetical optometric supply‐side scenarios are presented. Methods: Data from the Australian Bureau of Statistics on age and gender of people listing optometry as their major qualification in the 2001 census were projected over a 30‐year period, accounting for factors such as ageing, attrition, new graduates and migration. Data were compared to the numbers of optometrists calculated as necessary to meet the demand for services of the Australian population to 2031. Results: The projections indicated that in 2031, there would be 4,072 equivalent full‐time optometrists, an excess of 6.9 per cent compared with demand and that of these 38 per cent would be female. Application of a ‘high’ growth scenario, based on increases in the proportion of optometrists in active practice, working hours by females and graduate and immigrant numbers, resulted in a projected oversupply of up to 30 per cent. Use of a ‘low’ growth scenario, based on decreases in the proportion of optometrists in active practice, working hours, graduate and immigrant numbers, resulted in a projected undersupply of at least 21.5 per cent. Conclusions: Projected numbers of optometrists using current weightings for mortality, attrition, proportion of optometrists in active practice, working hours, immigration and new graduates indicate that in 2031, there will be adequate numbers of optometrists to meet the demand for services, if service utilisation is maintained at current levels or increased slightly. The adequacy of projected numbers varies considerably if alterations are made to the weighting factors using ‘high’ and ‘low’ growth scenarios.     

Geriatric optometry questionnaire.

A national survey of American Optometric Association Low Vision Section members was conducted by the newly formed Geriatrics and Low Vision Committee during the fall of 1989. The "Geriatric Optometry Questionnaire" was designed to establish a greater understanding of the nature of comprehensive professional services for the unique needs of visually impaired older persons. Of the 481 surveys mailed, 289 were returned for a response rate of 60 percent. Seventy-eight percent of the respondents had completed their formal optometric education after 1970. Results indicated that geriatric optometric care is predominantly delivered in private practices and in low vision agencies. Approximately 69 percent of the patients are above the age of 65, with the majority of those being under 85. Although the average initial low vision appointment lasts 60-90 minutes, this generally represents the low vision examination and evaluation of low vision devices only. Complete ocular health assessments combined with low vision evaluations are provided by only 33.5 percent. While 80 percent of the optometrists responding take psychosocial histories, only 60 percent routinely refer patients for social services and rehabilitative training. Similarly, 57 percent of those responding referred patients for independent daily living skills instruction and only 53 percent for orientation and mobility training. These data suggest that optometrists have not yet completely incorporated the multidisciplinary approach to geriatric health care and that continuing education in this area is needed.     

Board certification in optometry.

BACKGROUND: In keeping with current expectations in the health care community, the purpose of the American Board of Optometric Practice (ABOP) is to enhance the quality of optometric care available to the public by fostering continued competence for practitioners through administering education and examinations for certification and re-certification. The formation of ABOP makes possible for the first time a board certification process for optometrists. METHODS: The optometry model for board certification and recertification emphasizes the breadth of the profession. ABOP certification will be accomplished through a combination of examinations and high-quality, tested Board Certified Continuing Education (BCCE). Specific requirements for practitioners at various stages of their careers are presented. RESULTS: Board certification provides one important mechanism for an optometrist to demonstrate commitment to quality, professionalism, and ongoing clinical competence. The optometrist benefits from high-quality continuing education designed for timeliness, importance, and breadth. The public benefits by the enhancement of continued competence within the optometric profession. Health care agencies benefit by being able to recognize providers who have elected to demonstrate their qualifications through certification. CONCLUSIONS: Through board certification, optometrists will be able to demonstrate their commitment to maintaining clinical competence through a nationally uniform program, and they will be able to comply with standards that are generally recognized and required throughout the health care community.     

Optometric practice in Australian Standard Geographical Classification—Remoteness Areas in Australia, 2010

Background: This paper assesses the distribution of the optometric workforce and population per equivalent full‐time optometrist (EFTO) across the five Australian Standard Geographical Classification—Remoteness Areas (ASGC‐RA) categories in the states and territories of Australia. Methods: Data from the database of Optometrists Association Australia on the addresses of primary, secondary and visiting practices and the number of hours worked by optometrists were used to determine the number of EFTOs in each ASGC‐RA category in the states and territories. Population to EFTO ratios were calculated for each ASGC‐RA by using population data for 2009 and 2010 from the Australian Bureau of Statistics. Results: In the major cities (RA1), the proportion of optometric practitioners was greater than the corresponding proportion of the Australian population. The numbers of optometrists in the inner and outer regional areas (RA2 and RA3, respectively) were calculated as sufficient to provide an initial consultation to the corresponding populations every four to five years, while in the remote and very remote regions (RA4 and RA5, respectively), the numbers of optometrists were calculated as sufficient to provide an initial consultation once every nine or more years. Conclusions: The number of optometrists in practice in Australia is sufficient to meet the needs of the Australian population overall. The issue of the provision of optometric care in remote and very remote regions of Australia is unlikely to be addressed by increasing the number of optometrists as the sparse populations and the large areas over which these populations are spread are unlikely to be able to sustain optometric practices. This means that new service‐delivery models could be necessary for the provision of optometric services in these regions.     

Why should optometric research be designated as a priority for the profession?

Research is the discovery of new information, ideas or theories that increases our knowledge and understanding of ourselves and our environment. Optometric research focuses on the health, functioning and performance of people with emphasis on their eyes and vision. The goal of optometric research is to enable optometrists to provide high quality eye and vision care for their patients.     

Health planning and resources development: an opportunity for optometry.

The American Optometric Association views the goal of the National Health Planning and Resources Development Act of 1974, as the promotion of physical, emotional and environmental health for all. The National Health Planning and Resources Development Act will work towards this goal by identifying problems, preparing reports and studies and developing recommendations for implementation directed toward solving the problems. These functions will be carried out in collaboration with private and governmental individuals and organizations concerned with health care services. Only through this coordinated effort will success be achieved.     

The frequency of dilated diabetic eye examinations by optometrists in the state of ohio.

PURPOSE: The purpose of this study was to assess optometric care of diabetic patients. The American Optometric Association recommends dilated eye examinations at least once a year for people with diabetes. METHODS: Onsite chart reviews of 1497 diabetic patient charts were performed at a volunteer sample of Ohio-based optometric practices (n = 82). Four percent of all optometrists in the state of Ohio were surveyed. Data were collected from a 10-year period and included doctor age, membership in the Ohio Optometric Association (OOA) Diabetes Initiative, patient age, date of examinations, chief complaints, and dilation at examination. The primary outcome of the study was the frequency of dilated eye examination for diabetic patients by optometrists. RESULTS: Optometrists dilated 85.8% of diabetic patients at their last comprehensive examination. The percentage of diabetic patients dilated by optometrists increased from 40.0% in 1994 to 91.5% in 2003. The average time since last comprehensive eye examination for diabetic patients was 1.0 +/- 1.8 (mean +/- standard deviation) years. Diabetic patients who were dilated at a comprehensive eye examination returned to care on average 0.7 years sooner than those who were not dilated. Doctor-level factors related to a higher average percentage of dilations were younger doctor age (beta = -6.1%/10 years of doctor age; 95% confidence interval [CI], -10.1 to -2.1) and membership in the OOA Diabetes Initiative (beta = 11.6%; 95% CI, 2.3 to 20.8). CONCLUSIONS: There is variability in diabetic eye care by optometrists. However, the majority of optometrists surveyed in this study provided dilated eye examinations for their diabetic patients. Programs desiring to increase compliance to diabetic standard of care guidelines may benefit by targeting both doctors and patients.     

The role of the technician in optometric practice.

Members of the Indiana Optometric Association were asked to rate each of the duties which Indiana University optometric technician students are currently taught to perform. Rated on a four point scale from most desirable to undesirable, the duties deemed most important by respondents were those having to do with the dispensing of glasses and contact lenses as well as the usual receptionist and secretarial duties. The duties receiving the lowest ratings were keratometry and tonometry. However, there is good general agreement between the school and the profession concerning the content of the optometric technician program.     

OPTOMETRIC TECHNICIANS IN THE UNITED STATES AN INTERVIEW WITH STEVEN BATES

Steven Bates, O. D., is director of the Optometric Technicians Program taught in conjunction with the School of Optometry at the University of Alabama in Birmingham. Optometric technicians are a new, somewhat radical development in the United States, reflecting some of the modern trends in optometry and in the health professions generally. Some Australian optometrists will know Dr. Bates through his book “Fundamentals for the Optometric Assistant”. I began our conversation by asking Dr. Bates about the relationship of this book with the optometric technician.     

Optometric services to Aboriginal and Torres Strait Islander communities throughout Queensland

Inadequate access to eye care services and limited awareness of eye health issues are believed to be factors contributing to the relatively poor ocular health of the Aboriginal and Torres Strait Islander (A&TSI) population. This paper describes a survey of optometrists currently practising in Queensland, which determined their involvement in the provision of primary eye care to A&TSI people in urban and rural communities. Only half of the optometrists who responded to the survey provided optometric services to A&TSI communities and only a small percentage of these provided services to rural communities. There was also evidence that many optometrists are unaware of the poor ocular status of A&TSI people, yet many stated that they would be prepared to provide a service if there was a need in the community. The findings of this survey indicate a need for improvement in the optometric services offered to A&TSI communities in terms of their nature and accessibility. (Clin Exp Optom 1996; 79: 6: 215–226)