How ophthalmologists will work in the future


Hovanesian is a faculty member at the UCLA Jules Stein Eye Institute and in private practice at Harvard Eye Associates in Laguna Hills, California.

Disclosures: Hovanesian reports no relevant financial disclosures.

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How will we work differently when the burgeoning shortage of ophthalmologists makes it impossible to meet the demands for our services?

As the cover story of this issue of Ocular Surgery News discusses, the reduced number of surgeons and rising number of patients will challenge current practice patterns. Here are my predictions for how this will play out:

Cataract surgery will move into the office and be performed bilaterally on the same day. Ample evidence supports bilateral surgery, as we have explored in a previous cover story. Both the size and complexity of machinery to perform surgery safely will also need to be reduced. Shrinking facility fees and a shortage of space will mean these instruments will come down in size and capital equipment price tag. Companies are already preparing for subscription models for paying for equipment, so we will pay over time and per case, rather than a large upfront commitment for equipment.

John Hovanesian

A more consumer-driven market of procedures will emerge with expansion of patient-pay models. Advanced techniques such as precision pulse capsulotomy or femtosecond laser procedures will be increasingly demanded by a savvier population of patients. As now, the most successful practices will be those who can offer the “impossible” triad of high tech, high touch and high volume.

Fewer surgeons will perform complex cases such as penetrating keratoplasty, complex vitrectomy and elaborate oculoplastic procedures. Intense follow-up care simply won’t fit into the high-flow pattern in a private clinic. Already, glaucoma specialists are performing fewer tube shunts and trabeculectomies, giving way to combined MIGS procedures.

We will need to get comfortable with physician assistants and perhaps optometrists expanding their roles in performing procedures. The latter is a sensitive topic, but particularly in rural areas, this shortfall of labor already exists. The best way we can hand off these procedures is to ensure those performing them have adequate supervision and training to perform YAG lasers, retinal injections, collagen cross-linking and other procedures.

Larger, integrated practices have already begun preparing for these changes, demonstrating that we can still deliver high-quality care with a coordinated team approach. If we are a smart specialty (and we are), we’ll manage change for the benefit of both our patients and our practices.



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Elena Johaness

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