Ophthalmology Business

MAR 2014

Ophthalmology Business is focused on business topics relevant to the entrepreneurial ophthalmologist. It offers editorial, opinion, and practical tips for physicians running an ophthalmic practice. It is a companion publication of EyeWorld.

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March 2014 • Ophthalmology Business 25 and ophthalmology But just what do all the grim P CP shortage statistics mean for ophthalmology? And will there be a shortage of ophthalmologists as well? How will practicing ophthal- mology change in the future due to any projected shortages? Changing the ophthalmic practice model First, the news for an ophthalmology shortage: "Over the last decade, there's been an 11% drop in oph- thalmology residency slots," said John B. Pinto, president, J. Pinto & Associates, San Diego. "Thirty years ago, there was a 2 to 3% increase each year in the number of ophthal- mologists." However, that drop is countered with a material increase in the num- ber of optometrists now being trained and delayed retirements by ophthalmologists who may have planned to retire but are sticking around either for love of the profession or lack of retirement funds, Mr. Pinto said. Looking ahead, Mr. Pinto does not see a frank labor shortage within eyecare as a whole. Instead, over the next 20 years, he sees the eyecare practice model changing. "Someone who is 75 years old in 2025 or 2035 will get the needed eyecare, but they may get that care a little later than they do today and from a provider with a different level of training," he said. So instead of a glaucoma subspe- cialist seeing a routine glaucoma patient, a general ophthalmologist or optometrist might see that patient. A bilateral pseudophake who is postop cataract will be followed more often in the future by an optometrist rather than a cataract surgeon, Mr. P into said. There are signs of this practice shift already. "Most vanguard prac- tices are using mid-level providers much more often now," Mr. Pinto said, noting that surgeons will com- monly report that nearly a third of the work that they perform today can be done by an optometrist. By the same token, optometrists and ophthalmologists are both also delegating more work to technicians, Mr. Pinto said. This shift in practice patterns may help keep ophthalmologists more focused on the medical and surgical work that they truly want to do, Mr. Pinto said. However, with a growing patient demand and declin- ing reimbursement, ophthalmolo- gists of the future will need to work longer and harder than they do now to increase or even preserve income, he said. How the PCP shortage affects ophthalmology Ophthalmologists also must face some consequences of the projected PCP shortage. One consequence is a potential problem seeing patients who must be handed over by their PCP. "Specialists need primary care docs to take care of our patients' medical problems," said orthopedic surgeon Barbara L. Bergin, MD, Texas Orthopedics, Austin. Although Dr. Bergin is not an ophthalmologist, she said her specialty and others face a similar relationship with PCPs. "Many of our patients need medical clearance before they can have sur- gery. Sometimes it takes a long time for patients to see their primary care docs for medical clearance," she said. "We know PCPs are gatekeepers. T o get to specialists, we need to get them through the gate," said Saralyn Mark, MD, president, SolaMed Solutions, Washington, D.C. Dr. Mark is an endocrinologist, geriatrician, and women's health spe- cialist involved with organizational and legislative efforts to increase the re-entry of physicians back into medicine as a way to help bridge the shortage. Although nurse practitioners and physician assistants play a criti- cal role in meeting with patients, even those healthcare team members need to rely on PCPs, Dr. Mark said. Dr. Mark predicts that the dwin- dling number of PCPs may lead to specialists taking on a little more primary care-related responsibilities than they had planned. Matt Jacobson, CEO and founder of the concierge model SignatureMD, Santa Monica, Calif., made the same pre- diction. "If patients can't get to their doctor and they have a cold, they may go to an ENT specialist and get billed at a higher rate. Or they may have pink eye and go directly to an ophthalmologist instead," he said. Mr. Pinto estimates that only 3 to 5% of an ophthalmologist's patients come from PCP referrals. However, he does predict that it will be harder in the future for ophthal- mologists to get PCPs on the phone to coordinate care. Still, he noted those phone conversations are a rare occurrence, even if they are a good idea. Technology will play a role in helping ophthalmologists and PCPs manage any workload shifts due to shortages, said David Goldman, MD, assistant professor of clinical continued on page 26 20-28_OB March 2104-DL_Layout 1 2/19/14 11:09 AM Page 25

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