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Recession in Your Practice II:The Calm Before the Storm?

Opinion

Ihope you haven’t experienced adrop-off in practice volume becauseof the effect of copays in a declining

economy. If you haven’t, I doubt thatyou have logged a dramatic increase inrevenue, either. Most ophthalmologists,like other business owners, are beingextra cautious with buying and staffingdecisions. In this environment, slowingdown on wet pavement is sensible busi-ness strategy. But it also delays theinevitable because, as we have heard sooften recent ly, the Boomers are coming.The statistics are compelling, if not

alarming. According to Etzioni et al.,1

by 2010, the workload of ophthalmologywill increase 15 percent over 2001 levels,while the U.S. population grows only 7percent. In 2020, ophthalmic serviceswill need to be 47 percent above 2001levels, at a time when the population isup only 17 percent. Why the discrepan-cy? Because the bulk of ophthalmic ser-vices are delivered to those over 65, andthat’s the growth segment of the popu-lation. In fact, among the medical andsurgical specialties, only cardiothoracicsurgery and geriatrics are even close toophthalmology in projected growth.During his Keynote Address at the

2008 Academy Joint Meeting, Harvey V.Fineberg, MD, PhD, the president of theInstitute of Medicine, emphasized theneed for ophthalmology to get ready to care for this onslaught. But then hesaid something that his audience hadnot expected to hear. He said that oph-thalmology would need to team with

optometry to get the job done becauseneither profession will be able to do itby themselves. He suggested that weshould focus more on what optometrycan do, rather than what it cannot do, aswe move forward. I think he meant thatwe need a change in emphasis ratherthan a change in guiding principles.There is still a dividing line between“can do” and “can’t do” that needs to bevigorously defended and the Academywill continue to do that with yourimportant contributions to the SurgicalScope Fund and OphthPAC. But con-tinuing to do that does not rule out anew emphasis on activism in formingeye care teams, in which all membersare valued and respected for their con-tributions to quality patient care.The Academy’s Task Force on Eye

Care Delivery that was headed by Paul P.Lee, MD, JD, concluded that there wasnot one practice model that would fitall situations; innovations in meetingthis need would come from all of uscollectively. Different practice circum-stances and attitudes should dictatehow eye care teams are constructed anddeployed, hopefully respecting ethicalprinciples and training differentials,with the goal to increase practice effi-ciency and throughput while increasingquality of care. Translated, this meansthat individual ophthalmologists willneed to assess their own practice needs,call on the extensive information avail-able through the Academy (visit www.aao.org/efficiency), and implement

changes in their practice accordingly.It’s far too late to increase the numberof ophthalmologists being trained tocare for the demographic shift; thepipeline is too long for that. Efficiencytweaks are unlikely to increase our pro-ductivity by the requisite 50 percent.During this calm while the eye of therecession passes over us, it might be agood time to plan for changing the waywe practice by increasing productivity,creating eye care teams, or both.

1 Etzioni et al. Ann Surg 2003;238:170–177.

The opinions expressed are solely those of

the Chief Medical Editor. Rebuttals are wel-

come.

richard p. mills, md, mph

chief medical editor, eyenet

richard p. mills, md, mph