Today we are facing many difficult issues in medicine and in ophthalmology. While there are many areas of concern, a central issue is whether ophthalmologists will be able to continue to supply quality eye care to patients over the next 10 to 15 years as a major demographic shift occurs in the population. The issues of expanding need, limited financial resources and a potential shortage of providers present a challenge that we may fall short of meeting.
The population is aging, and projections show an increase of 50 percent in the number of cataract, glaucoma and macular degeneration cases by 2020. The incidence of diabetes mellitus continues to rapidly rise. Over the next 15 years, as the population increases and ages, the number of practicing ophthalmologists will grow only slightly. It is predicted that ophthalmology will have one of the largest provider shortages of any surgical subspecialty by 2020. And all of this is occurring at a time of cuts in reimbursement and a growing unwillingness by society to increase medical spending.
How can we as ophthalmologists assure the sustainability of quality eye care? What needs to be done?
First, we must continue to commit to the development of new knowledge and skills through research and the transferring of this knowledge to the practicing clinician to assure that our care is the best possible.
Second, we need to create effective systems using the resources available to deliver eye care to all who need it. We have to become more efficient while still maintaining the quality of care we supply our patients. A willingness to adapt our practices to a changing health care environment will be essential.
Third, society must recognize that quality health care requires appropriate and fair reimbursement to medical providers. We cannot each year face 5 to 6 percent cuts in reimbursement while dealing with increasing overhead and still maintain the present level of medical care. While ongoing increases in health care costs need to be addressed, this must be done in a way that allows for the economic sustainability of ophthalmic practices.
The Academy’s board of trustees—through education, provision of practice resources and advocacy—is committed to addressing these issues. The Academy has a special task force examining how best to meet these challenges. These are hard, long-term problems with no easy solutions. Who will provide the services? How will these services be financed? What services are cost effective? Who should receive the services? Over the last 15 years there have been dramatic shifts in practice patterns, including optical dispensing, a major shift to ambulatory surgery centers, and the increased use of technicians and optometrists in our practices.
What changes will be necessary in the next 15 years? What practice patterns and models will work best? Maintenance of certification, pay for performance, information technology, evidence-based medicine, genetically based therapies and scope of practice issues—all will be components of this process. However, the overriding issue will remain whether we can devise and implement systems that are effective and efficient in meeting our patients’ eye care needs and that are also sustainable economically. This year, together, we must make progress in addressing these challenges.