The Optometry Surplus: A Quantitative Determination of Excess Densities

Parameters Determining Density

Density of Optometrists

1: D = number of optometrists per 100,000 population can also used to quantify future demand levels per 100,000. A surplus exists if D of supply exceeds D of demand.

D varies considerably from state-to-state, as it does for physicians, dentists and other doctorial health providers. While some believe increasing the supply of health providers “smoothes” out these variations, there is evidence it does not and “mal-distributions” continue despite increased numbers of providers. Offering financial incentives [loan forgiveness and bonuses] appear more effective.

National D values are used to indicate relative supply and demand over time. The levels since Abt. and the AOA felt supply equaled demand in 1997 with D = 11.5 is used as a benchmark of supply equal to demand. D has already risen to 13.4 as Abt. predicted.

2: Population and its Growth

The study uses future population estimations of the US Census Bureau.

3. Numbers Graduating from Schools of Optometry.

This data is available since1940. Based on entering 2012 enrollments, the graduation rate will exceed 1,700 in 2016 and by 2018 may reach nearly1,900. This study assumes no additional schools open and graduation rates remain in a range of 1,700 to 1,900 per year.

4. Demand for Optometry Care

In 1970 an article by Pennel & Delong opined D = 13-14 would be required for “good” care if every US citizen were eligible for free, comprehensive care under a future National Health Care Plan. In 1972, AOA’s “Optometry Today: The Vision Profession” stated an optimum density was 13-14. See also Mote [JAOA, No. 40, Dec., 1969] But there remains no quantitative determination of optimum D. Instead, manpower studies have attempted to predict demand based upon algorithms and assumptions. In truth, D has been driven by the number of schools and their class sizes with no master plan.

D has been under 12 for most of the last 60 years and, at its brief record 14 in 1964 from “GI Bill” students, when enrollments quadrupled, considerable numbers of graduates experienced difficulty establishing practices.

“Demand” is strongly influenced by the degree to which medical insurance and vision benefit programs provide eye/vision coverage, the cost of co-pays, the state of the national economy and the political climate set by special interest groups lobbying for health care. Predicting future demand is thus a guessing game.

It is not possible to accurately quantify future “demand” and this study will not do so other than observe supply equaled demand at D = 11.5 in 1997 and there is probably a surplus now as predicted by Abt. Instead, readers can predict future required D’s and use the attached charts and figures to determine the extent of future surpluses.

The reference point is 1997 when supply equaled demand for optometry services at D=11.5. The charts show surpluses for future demands ranging from D =11.5 to 14.0.

Past Optometry Manpower Studies:

1. RAND Corporation Workforce Study.

Released in 1995 by the RAND “think tank”, and sponsored by the American Academy of Ophthalmology, this study included ophthalmologists and optometrists and postulated three future systems in which they would practice. The AOA did not participate.

In all 3 future systems, RAND projected surpluses of ophthalmologists and optometrists, including the system in which patients decided whether they would seek care first from an ophthalmologist or optometrist.

2. Project Hope National Census of Optometrists

In 1997 the national “Project Hope Census of Optometrists” [supported by the AOA] determined there were 30,510 practicing optometrists and the US Census Bureau report for 1997 stated national population was 266,490,000. These yield a density D of 11.5 in 1997.

3. Abt. Associates Manpower Study

In 2000, Abt. Associates of Cambridge Mass. released its “Workforce Study of Optometrists”. Funded by the AOA and with an AOA Workforce Committee providing “data, advice, criticism and support”, the Project Hope Census data of 1997 was used as the base upon which it developed projections of future supply and demand for optometrists.

Abt. assumed the supply of optometrists equaled demand in 1997 [D = 11.5] and, as the graduation rate of optometrists had been almost constant [1,023-1,232] from 1983 to 1995, assumed a constant graduation rate of 1,127 through 2030.

Acting with the advice and suggestions from its AOA Advisory Committee, Abt. projected a surplus of optometrists that would grow to 10% [just over 4,000] in 2013-2017 and then decline by 2030. [Figure 5]

optometry manpower chart #5.jpg

As a test of its accuracy, Abt. projected a total of 39,685 optometrists by 2012 and in 2013 the AOA reported 40,000 were in practice in 2012 which is a reasonable match.

But the number of graduates began to increase above 1,127/year after the Abt. report and if one adds those additional graduates to the Abt. projection for 2012 it becomes 40,058, an almost exact match with the AOA 2013 report of 40,000 for 2012.

This close match of the Abt. supply projection for 13 years in the future demonstrates the Abt. supply model and its predictions of surpluses were accurate up to 2012 but are now underestimations of surpluses because graduation rates are above the 1,127 assumed by Abt.

When Abt. made its study there were 13 U.S. schools graduating 1,127 per year but in 2018 there will be 22 U.S. schools graduating perhaps as many as 1,900 per year.

The Abt. data base for its supply algorithm could be updated using post-1997 graduation rates by adjusting Table 5.17 (page 10) graduation rates in Column #1 and re-computing Column #3 (surplus) and Column #4 (% surplus).

Conclusions from Abt. Study.

The Abt. modeling for supply was accurate for 13 years but its future predicted surpluses are now underestimates.

The Abt. “Optometric Workforce Simulator”…”we developed a flexible forecasting tool that can produce workforce estimates under a range of future scenarios.” could have been updated if the AOA wanted to account for increased numbers of graduates but it choose, instead, to fund a new study by the Lewin Group which is yet to be released.

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