-
Canadian Journal of Ophthalmology.... Dec 2016
Topics: Canada; Education, Medical, Graduate; Forecasting; Health Services Accessibility; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Surveys and Questionnaires
PubMed: 27938947
DOI: 10.1016/j.jcjo.2016.07.022 -
JAMA Ophthalmology Jan 2018As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether...
IMPORTANCE
As the United States considers how to best structure its health care services, specialty care availability is receiving increased focus. This study assesses whether patients lack reasonable access to ophthalmologists in states where optometrists have been granted expanded scope of practice.
OBJECTIVE
To determine the estimated travel time (ETT) to the nearest ophthalmologist office for persons residing in states that have expanded scope of practice for optometrists, and to quantify ETT to the nearest ophthalmologist for Medicare beneficiaries who received surgical care from optometrists in those states between 2008 and 2014.
DESIGN, SETTING, AND PARTICIPANTS
This study used data from the 2010 US census, a 2016 American Academy of Ophthalmology member database, and a data set of claims data for a random sample of 20% of beneficiaries enrolled in Medicare nationwide from 2008 to 2014 (n=14 063 725). Combining these sources with geographic information systems analysis, the ETT to the nearest ophthalmologist office was calculated for every resident of Kentucky, Oklahoma, and New Mexico. This study also assessed ETT to the nearest ophthalmologist for Medicare beneficiaries in those states who had received surgery from an optometrist from 2008 to 2014. Data analyses were conducted from July 2016 to July 2017.
MAIN OUTCOMES AND MEASURES
The proportion of residents of Kentucky, Oklahoma, and New Mexico who live within an ETT of 10, 30, 45, 60, or 90 minutes of the nearest ophthalmologist office.
RESULTS
The study included 4 339 367 Kentucky residents, 3 751 351 Oklahoma residents, and 2 059 179 New Mexico residents. Of these, 5 140 547 (50.6%) were female. Racial/ethnic composition included 7 154 847 people (70.5%) who were white, 640 608 (6.3%) who were black, and 1 418 246 (14.0%) who were Hispanic. The mean (SD) age was 37.8 (22.8) years. More than 75% of residents in the 3 states lived within an ETT of 30 minutes to the nearest ophthalmology office, and 94% to 99% of residents lived within an ETT of 60 minutes to the nearest ophthalmology office. Among Medicare beneficiaries who received surgery by optometrists, 58.3%, 51.1%, and 46.9% in Kentucky, Oklahoma, and New Mexico, respectively, lived within an ETT of 30 minutes from the nearest ophthalmologist office.
CONCLUSIONS AND RELEVANCE
In the states where optometrists have expanded scope of practice, most residents lived within an ETT of 30 minutes of the nearest ophthalmologist office, as do half of Medicare beneficiaries who received surgical care from optometrists. These results can help inform policy makers when weighing the pros and cons of scope of practice expansion for optometrists.
Topics: Female; Health Services Accessibility; Humans; Male; Ophthalmologists; Optometrists; Patient Care Team; Population Surveillance; Practice Patterns, Physicians'; Retrospective Studies; Time Factors; Travel; United States
PubMed: 29167903
DOI: 10.1001/jamaophthalmol.2017.5081 -
American Journal of Ophthalmology Sep 2023To describe the gender trends in ophthalmology primary practice areas using the American Board of Ophthalmology (ABO) diplomates.
PURPOSE
To describe the gender trends in ophthalmology primary practice areas using the American Board of Ophthalmology (ABO) diplomates.
DESIGN
A trend study plus a cross-sectional study of the ABO's database.
METHODS
The de-identified records of all (N = 12,844) ABO-certified ophthalmologists between 1992 and 2020 were obtained. The year of certification, gender, and self-reported primary practice for each ophthalmologist was recorded. Subspecialty was defined as the self-reported primary practice emphasis. Practice trends of the entire population and the subpopulation of subspecialists were explored based on gender and were then visualized using tables and graphs and analyzed using the χ or Fisher exact test.
RESULTS
A total of 12,844 board-certified ophthalmologists were included. Nearly half (47%) reported a subspecialty as their primary practice area (n = 6042), of whom the majority were male (65%, n = 3940). In the first decade, men outnumbered women reporting subspecialty practices by more than 2:1. Over time, the number of women subspecialists increased whereas the number of men remained stable, such that by 2020 women comprised almost half of new ABO diplomates reporting subspecialty practice. When all subspecialists were compared within gender, there was not a significant difference (P = .15) between the percentage of male (46%) and female (48%) ophthalmologist reporting a subspecialty practice. However, a significantly greater proportion of women than men reported primary practice in pediatrics (20.1% vs 7.9%, P < .001) and glaucoma (21.8% vs 16.0%, P < .0001). Alternatively, a significantly greater proportion of men reported primary practice in vitreoretinal surgery (47.2% vs 22.0%, P < .0001). There was no significant difference between the proportion of men and women reporting cornea (P = .15) or oculoplastics (P = .31).
CONCLUSIONS
The number of women in ophthalmology subspecialty practice has increased steadily over the past 30 years. Men and women subspecialize at the same rate, but significant differences exist between the types of ophthalmology practiced by each gender.
Topics: Humans; Male; Female; Child; United States; Ophthalmology; Cross-Sectional Studies; Certification; Ophthalmologists; Self Report
PubMed: 37142172
DOI: 10.1016/j.ajo.2023.04.012 -
JAMA Ophthalmology Jan 2018Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages...
IMPORTANCE
Understanding the distribution of patient complaints by physician age may provide insight into common patient concerns characteristic of early, middle, and late stages of careers in ophthalmology. Most previous studies of patient dissatisfaction have not addressed the association with physician age or controlled for other characteristics (eg, practice setting, subspecialty) that may contribute to the likelihood of patient complaints, unsafe care, and lawsuits.
OBJECTIVE
To assess the association between ophthalmologist age and the likelihood of generating unsolicited patient complaints (UPCs) among a cohort of ophthalmologists.
DESIGN, SETTING, AND PARTICIPANTS
Retrospective cohort study with variable duration of follow-up. The study assessed time to first complaint between 2002 and 2015 in 1342 attending ophthalmologists or neuro-ophthalmologists who had graduated from medical school before 2010 and were affiliated with an organization that participates in Vanderbilt University Medical Center's Patient Advocacy Reporting System. Participants were stratified into 5 age bands and were followed up from the time of their employment to receipt of their first complaint. Trained coders categorized UPCs into 34 specific types under 6 major categories.
MAIN OUTCOMES AND MEASURES
Time to first recorded complaint. Multivariable Cox proportional hazards model was used to measure the association between time to first complaint and ophthalmologist age after adjustment for predetermined covariates.
RESULTS
The median physician age was 47 years, with 9% who were 71 years or older. The cohort was 74% male, 90% held MD degrees, and 73% practiced in academic medical centers. The mean follow-up period was 9.8 years. Ophthalmologists older than 70 years had the lowest complaint rate (0.71 per 1000 follow-up days vs 1.41, 1.84, 2.02, and 1.88 in descending order of age band). By 2000 days of follow-up (or within 5.5 years), the youngest group had an estimated UPC risk of 0.523. By 4000 days (>10 years), participants in the older than 70 years age band had an estimated risk of UPC of only 0.364. The 2 youngest age bands were associated with a statistically significant shorter time to first complaint. Compared with those aged 71 years or older, the risk of incurring a UPC for those aged 41 to 50 years was 1.73-fold higher (hazard ratio [HR], 1.73; 95% CI, 1.21-2.46; P = .002). Similarly, participants aged 31 to 40 years had a 2.36 times higher risk of incurring a UPC (HR, 2.36; 95% CI, 1.64-3.40; P < .001).
CONCLUSIONS AND RELEVANCE
This study suggests that older ophthalmologists are less likely to receive UPCs than younger ones. Although limitations in the study design could affect the interpretation of these conclusions, the findings may have practical implications for patient safety, clinical education, and clinical practice management.
Topics: Adult; Aged; Female; Follow-Up Studies; Humans; Male; Malpractice; Middle Aged; Ophthalmologists; Patient Safety; Patient Satisfaction; Physician-Patient Relations; Practice Patterns, Physicians'; Quality Indicators, Health Care; Reproducibility of Results; Retrospective Studies; Risk Factors
PubMed: 29192303
DOI: 10.1001/jamaophthalmol.2017.5154 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Internship and Residency; Ophthalmologists; Ophthalmology; Pandemics; Physical Distancing; SARS-CoV-2; Stress, Psychological
PubMed: 32971023
DOI: 10.1016/j.ajo.2020.06.048 -
Klinische Monatsblatter Fur... Nov 2020Optic neuritis is a special challenge to the ophthalmologist. It is a relatively frequent condition but difficult to seize morphologically. It has neurological...
BACKGROUND
Optic neuritis is a special challenge to the ophthalmologist. It is a relatively frequent condition but difficult to seize morphologically. It has neurological implications and is subject matter of recent trials.
METHODS
Selective literature search including the authors' professional experience.
RESULTS
Practical aids for the ophthalmological management of optic neuritis are derived from the best available evidence and the recent literature is discussed.
CONCLUSIONS
The present paper provides evidence-based recommendations for a safe handling of optic neuritis as well as information on current issues.
Topics: Humans; Ophthalmologists; Ophthalmology; Optic Neuritis
PubMed: 33202461
DOI: 10.1055/a-1276-1728 -
Clinics (Sao Paulo, Brazil) 2020
Topics: Brazil; Humans; Ophthalmologists
PubMed: 33206765
DOI: 10.6061/clinics/2020/e2201 -
American Journal of Ophthalmology Dec 2020
Topics: COVID-19; Humans; Ophthalmologists; Pandemics; Patient Advocacy; SARS-CoV-2
PubMed: 32961114
DOI: 10.1016/j.ajo.2020.07.016 -
Current Opinion in Ophthalmology Sep 2022To assess the impact of private equity acquisitions on physician career considerations, with particular attention to stage of career. (Review)
Review
PURPOSE OF REVIEW
To assess the impact of private equity acquisitions on physician career considerations, with particular attention to stage of career.
RECENT FINDINGS
Recent studies have demonstrated a clear increase in private equity acquisitions in ophthalmology, particularly in retina-oriented practices. Survey-related publications of recent fellow graduates may provide insights regarding considerations of early career ophthalmologists, whereas commentaries from senior ophthalmologists offer insights to considerations of late career physicians. To date, no published evidence exists regarding the differential financial and/or professional effects of private equity acquisitions on ophthalmologists with regards to career stage. Such effects may differ on the specific structure, nature, and terms of the private equity acquisition.
SUMMARY
Private equity acquisitions in ophthalmology may have several short-term, mid-term, and long-term effects on physicians over a variety of financial and career considerations. As such, there may be a differential effect of private equity acquisitions on early, mid, and late career physicians. Future outcome-related data will be necessary to fully understand the impact of private equity acquisitions on physicians both professionally and with regards to clinical care.
Topics: Humans; Ophthalmologists; Ophthalmology; Physicians
PubMed: 35916567
DOI: 10.1097/ICU.0000000000000872 -
European Journal of Ophthalmology Jan 2023This study is aimed to evaluate the clinical approach of non-pediatric ophthalmologists, working in community-based clinics towards Pediatric Patients and their...
BACKGROUND
This study is aimed to evaluate the clinical approach of non-pediatric ophthalmologists, working in community-based clinics towards Pediatric Patients and their management including referral rates to Pediatric Ophthalmologists and Orthoptists.
METHODS
an online survey was sent to all community ophthalmologists through national society and social media platforms. The questionnaire included questions regarding the responders' professional experience as well as regarding the responders' approach to children younger than 8 years, and the level of confidence in 4 main aspects of children's management and referral rates.
RESULTS
93 physicians working as general ophthalmologists completed the questionnaire. Most respondents have been in practice for over 10 years (64/93, 68.8%) and over two-thirds were also hospital affiliated (65/93, 69.1%). The responders estimated on average that 35.1 ± 29.6% of patients under 8 years of age are referred for a consult to a pediatric ophthalmologist The level of confidence of three aspects unique to Pediatric Ophthalmology; cycloplegic refraction, strabismus evaluation, and prescribing glasses were significantly lower ( < 0.01) than confidence in performing a basic eye exam.
CONCLUSIONS
many Ophthalmologists do not feel fully capable or experienced to perform the appropriate tests for the pediatric population, especially during the critical timeframe, before 8 years of age. The very high rate of referrals stands in contradiction to the reported low rate of eye pathologies in the pediatric population. These findings suggest that more pediatric-specific training is needed to improve the physician's skills to perform a comprehensive evaluation of pediatric patients in order to reduce the referral burden.
Topics: Child; Humans; Ophthalmologists; Strabismus; Ophthalmology; Surveys and Questionnaires; Referral and Consultation
PubMed: 35795924
DOI: 10.1177/11206721221111885