Article Date: 12/1/2001

Are There Too Many O.D.s?
Two opposing views on whether we're meeting unmet vision needs.

"No. We'll need more optometrists if we're to address this country's growing eyecare needs."
IRVING BENNETT, O.D., F.A.A.O., Sarasota, Fla.



Are we facing an oversupply of optometrists? We are, if you take the Workforce Study of Optometrists commissioned by the American Optometric Association literally. The study, released in February 2000, concluded that all things being equal, we'll see a substantial oversupply of optometrists in the next 2 or 3 decades.

But I believe that all things aren't equal and that this projected overabundance could easily turn into an undersupply. To avoid having too few optometrists, the following would have to remain true:

But none of these assumptions is guaranteed. Let's look at each one in more detail.

Demand for service. The demand for eyecare services is likely to increase. Aging baby boomers, the growing focus on eye exams for infants and children, the expected increase in eye diseases needing treatment and the increase in computer use and its associated vision problems are some of the factors increasing eyecare demands.

Enrollment statistics. Enrollments in optometry schools and residency programs for ophthalmologists are slightly declining. However, this decline will have little effect in the short term because many students are currently in the pipeline.

Government recommendations. No one knows what the federal government will do with eye care, but state governments signal a trend. Last year, for instance, Kentucky passed legislation requiring all students to have full eye examinations before entering school. Similar legislation is currently under consideration in half a dozen other states.

At present, many vision and eyecare needs go unmet. For instance, more than 40% of the U.S. population has never had their eyes examined. If O.D.s strive to meet these needs, the country will need more of us -- not fewer.

We need to convince consumers that routine eye exams are necessary to discover ocular and systemic problems. We also need to persuade them that comfortable vision results in more efficiency at the workplace and more enjoyment in life overall. We need to induce those who periodically get eye exams that just seeing well for distance or near objects isn't enough -- that good vision goes far beyond that.

What's more, we need to visually evaluate young children (not just screen them) and make sure that motor vehicle operators see properly to drive. We need to give people whose vision we can't correct by customary means the opportunity for correction using less common means. And we need to arrange to examine our population on a more regular basis so that we can discover systemic conditions, such as diabetes, that manifest through eye problems.

Doing the numbers

Statistics on current vision-related problems and conditions suggest the scope of the particular needs that go unmet.

Calls to action

Addressing these many problems will take both individual effort from ECPs and collective efforts from eyecare groups and associations.

Here's what we can do about some of the major issues that confront us:

Individual efforts

Collective efforts

Eyecare associations should issue periodic media releases with low-vision data and information on the correction of partially sighted persons. They should also join with groups such as Lions Clubs International to develop publicity programs on low vision.

These groups should also work on getting Medicare and Medicaid payment for low-vision devices.

Individual efforts

Collective efforts

Individual efforts

Collective efforts

Individual efforts

Collective efforts

Individual efforts

Collective efforts

Continuing to meet needs

Other unmet needs, including protecting the eyes of people who have home workshops and those employed in hazardous occupations, remain. A growing number of children and adults participate in contact sports or work with animals and need impact-resistant ophthalmic lenses and frames.

Meeting the unmet vision needs of America requires both individual and united efforts. In no instance is this self-serving. We'll need more optometrists to guarantee the public's visual welfare, which is, after all, our paramount concern.

I've looked at the subject of unmet needs and the number of optometrists needed to fill them now and in the future, much as the optimist and the pessimist look at a half-full or half-empty glass of water. I see our situation as a half-full glass. OM

Dr. Bennett practiced optometry for more than 40 years in Beaver Falls, Pa. He has authored numerous articles and lectured on practice management subjects. At one time, he was editor and publisher of OM. He was also a member of the AOA Project Team that commissioned the Workforce Study mentioned in this article.


"Yes. The market is already supersaturated, and we need to take other measures to address unmet vision needs."
LOUIS J. CATANIA, O.D., Atlantic Beach, Fla.

Nobody likes to try to refute one of the legends and heroes of our profession. Nor do they like to tell their beloved colleagues that our profession is in serious trouble.

But I feel that it's unacceptable to sit by and watch the profession that I love and for which I have shed blood for over 30 years, be pandered to, patronized and fed "whitewashed" information. Rather, someone must share some hard realities with those optometric practitioners who wonder, "Am I the only one hurting?"

No, my friend. In spite of the "conspiracy of deceit" our profession is enduring from Pollyannas in our professional journals and from professional associations trying to provide "feel good" rhetoric, your pain is all too real. And unless you understand the hard, painful realities, their causes and potential effects, our profession may not survive the next decade or two.

Point-by-point rebuttal

The arguments about the need for more optometrists to meet an array of "unmet vision needs" don't address the real critical issues optometry is facing. We must address these real issues (securing quality optometry school applicants and addressing the changing environment, to name a couple) if our profession is to survive and grow in the coming decades.

Demand for service. Yes, the demand for eyecare services will increase over the next 2 or 3 decades. However, sources will meet that demand in different ways than we currently address eyecare needs. Eye care practitioners (ECPs), especially the growing number providing third-party and federally reimbursed care, will continue to experience financial squeezing and will need to provide services more efficiently for more patients.

Technology will help with that efficiency (if optometry adapts to and adopts new technologies quickly enough -- that is, before our medical and optical competitors do). However, we'll still feel negative financial implications, which will affect our future modes of practice. When have increased third-party care and federal reimbursement ever helped providers financially?

Enrollment statistics. The decline in optometry school enrollments may not ultimately be as much a question of quantity as one of quality.

Government recommendations. The government will administer entitlement programs in Kentucky and those ". . . under consideration in half a dozen other states" for young and old in the most cost-effective manner.

Access to care improves with entitlement programs, but neither financial benefits to professionals nor better eye care to patients has ever been a byproduct of such programs.

Refuting the numbers

The following are my thoughts on the statistics that suggest that particular needs are going unmet:

The real issues

I see optometry's future in serious jeopardy. In fact, the optometric profession faces a crisis based on a number of current and evolving issues that I'll attempt to summarize.

Optometric education and thus the future of our profession are in harm's way. The cost of an optometric education (especially in the private schools) continues to escalate, while the financial value of the end product of such an investment continues to diminish.

Obviously, this situation will ultimately produce a reduction in overall enrollment in optometry schools. But the more insidious problem is one of securing quality applicants.

Consider that the highly qualified undergraduate student can choose a career in optometry (or any health profession), business, computer science, engineering, etc. All of the latter options may or may not require an extra year or two of training at moderate undergraduate or master's level tuition rates, plus living expenses and a resultant lost income for the extra educational time. Most of these careers have entry level earning potentials of $40,000 to $80,000 with virtual open-ended, long-term (ceiling) earning potential.

Meanwhile, optometry requires an additional 4 years postgraduate training at expensive, doctoral-level tuition rates plus living expenses. Potential state university totals could reach $70,000 to $100,000, while private school totals and living expenses could go as high as $180,000 -- plus 4 years of lost income.

This investment in an optometric education results in an entry-level income potential of $30,000 to $60,000 and probable potential earning ceilings that are substantially less than many other professions (especially with health care's increasing third-party and federal reimbursement controls).

Granted, while many qualified undergraduate students may have an emotional calling to "be a doctor," the painful financial realities of choosing optometry as a career are yielding continually decreasing numbers of qualified applicants to optometry schools (the pool of "legitimate" applicants is already less than the available seats in optometry schools) and there isn't anything on the horizon to suggest this crisis will improve.

The philosophy of "more is better" regarding the number of practicing optometrists is beginning to show its deleterious effects. Optometric academic institutions are primarily tuition-based operations (especially the private schools) that need to have a minimum number of students to meet their budgets. Thus, we can't realistically expect them to address this problem for our profession.

Again, notwithstanding the rationale for "increasing vision needs" and thus a need for more optometrists, this constant influx of new optometrists (without an equilibrating attrition rate) has resulted in an already supersaturated marketplace of ECPs (both O.D.s and M.D.s), getting worse.

Meanwhile, market influences, demographics and technological advancements continue to reduce the need for so many ECPs. Market-wise, commercial practices are providing an increasing volume of eye care, for better or for worse, with a system of fewer optometrists seeing more patients.

Demographically, increasing numbers of ophthalmologists (now being termed "comprehensive ophthalmologists") continue to see more routine eyecare visits (with technicians doing their refractions) at greater rates and volumes than comprehensive, routine optometric providers.

And last, but definitely not least, new technologies and appropriate delegation of data-gathering functions continue to increase the efficiency of providing routine eye care. These three influences are dramatically changing the landscape of the way eye care is currently being delivered and how it will be delivered in the future.

We must analyze any discussions about the "need for more optometrists" in the light of these changes and realities in the eyecare delivery system.

Because we have such limited control over them, the previous issues I've identified are frustrating to those of us who so dearly want to see our profession survive and grow.

One last issue, however, I feel is the most relevant because it's one that we do have control over, which ultimately leads to our control over our own professional destiny. It's our need to honestly and realistically address the changing environment that our profession faces and to deal with the critical issues we face as a profession.

Tackling some tough realities

Our only hope as a "minority profession" (as Dr. Alden Haffner has described us) is to recognize the realities we face, look to the future and structure a plan to address the critical needs for success. I suggest that we must:

Building a better future

I've always said that we see further by standing on the shoulders of such giants as Dr. Irving Bennett. But now, with the greatest humility and respect for Dr. Bennett and his predecessors, and in appreciation for all they've done for our profession, I believe it's time to look ahead and realistically address the challenges of optometry's future. To do this, though, we must address the aforementioned points quickly and efficiently.

Dr. Catania is an internationally acclaimed clinical educator and author. He is a recognized expert in anterior segment care, refractive surgery and new eyecare technologies. He's currently performing clinical research on the cornea and is developing eyecare technologies as well as serving as a consultant and advisor to multiple ophthalmic companies and professional journals. He holds academic ranks at numerous educational institutions and continues to write and lecture extensively worldwide.


Optometric Management, Issue: December 2001