Too Many Patients, Not Enough Providers

The US health care system has experienced seismic changes while working to keep its proverbial head above water to navigate a global pandemic. Economists and health care experts report an insatiable demand for health care services, while health insurance payers enjoy significant profits in the face of rising premiums, Medicare payment reductions, and faltering value-based care models. This grim outlook has resulted in an exodus of health care workers across many fields.¹

SHINING A SPOTLIGHT ON A PREVALENT PROBLEM

The reality of a broken system is beginning to emerge, highlighting the doctor and health care worker shortage that is further burdened by an aging population.² This reality is reaching a crisis level in rural America.³ Health outcomes are worsening, and the average US life expectancy has dropped by 3 years.⁴ These statistics are skewed disparately by education and neighborhood. The longitudinal debate about how to solve our health care system woes rage on, with limited solutions emerging, despite rapid-paced health tech innovation.

We need to persevere through these rocky times and continue to advocate for our patients, communities, and our practices. Innovations in precision medicine, outcomes, and treatments will emerge as we enter the data age, but optometrists and ophthalmologists must work together to properly triage patients with the singular mission of saving vision—and lives—in the face of the health care worker shortage in our country.

Optometry and ophthalmology can support each other and the larger health care system by finding efficiencies and by better using technology while working to sway health care policy changes in the face of likely ongoing increases in health care provider shortages.⁵ Optometry is particularly well-positioned on the frontline of health care, as we demonstrated during the pandemic by supporting ERs, urgent care centers, and the vaccination effort. We can remain invaluable assets and address health disparities and cost drivers in our communities, where provider shortages are particularly high, by understanding some basic tenants for survival, which I describe below.

Create a Patient-Centered Culture

Patient engagement is now center stage in most hospital systems, and the National Academy of Medicine has long recommended a focus on patients, noting that it improves quality of care, saves on resources, and engenders trust.⁶ This means asking patients what they need and understanding how they perceive care, form trusted relationships, and engage.

On a practice level, improving customer service may be as simple as implementing a patient portal or offering continuous care technologies, telehealth visits, and emergency call services. Optometrists who are present in almost all counties in the nation and who often have longitudinal patient relationships can advocate patient and family preferences, values, cultural traditions, and socioeconomic factors as leaders in their communities.⁷ We know the social determinants of health in our communities and must participate in policy change to support our patients in order to improve access to care in a provider shortage environment.

Keep Care Going at Home

Partner with technology companies that develop low-cost instrumentation to leverage multiple data sources from combined biometrics and patient inputs. Patients need continuous care and early warning systems to prevent vision loss and other morbidity and mortality. For example, vision testing at home that links to the doctor’s office may help prevent vision loss in patients with age-related macular degeneration, while home IOP monitoring may help identify patients at higher risk for glaucoma progression.^8,9 These types of systems can act as physician extenders and allow more care to occur at home while freeing up in-office appointments for more urgent triage. Triage innovations and care at home can further support the provider shortage.

Continue the Effort to Join Forces

Integrating your systems with other health care data systems is critical to improving patient outcomes, provider decision-making, and efficiency. The systems for accomplishing health information exchange (HIE) are slowly emerging, but many optometrists and ophthalmologists may not be aware of the national efforts to accomplish this.¹⁰

The 21st Century Cures Act mandated the inception of HIE by creating a Centers for Medicare & Medicaid Services-quality reporting category for improving interoperability. This came about because research showed that patient safety and care quality improved when doctors shared information across practices, pharmacies, and hospitals.^11,12 HIE exchange capability allows importation of patient problem and medication lists with a few clicks. Use of this technology can streamline the referral process between optometrists, ophthalmologists, and other providers by reducing the likelihood of duplicate or unnecessary testing.¹³

Make Your Referrals Count

Ensure that the shortages in ophthalmology surgical subspecialties¹⁴ are not overburdened by referring to subspecialty ODs for retina, cornea, myopia management, pediatric, low vision, and rehabilitation vision care cases.

In many rural areas, the crisis-level shortage of vitreoretinal and cataract surgeons requires optometrists to practice at full scope to coordinate patients in need of specialty care.¹⁵ Selecting the right specialist often reduces patient visits, travel, and complications. Research confirms that electronic referrals, information exchange systems, and insurance coverage and networks must be considered in making specialty referrals to reduce unnecessary referrals.¹⁶ Similarly, prepare for the best in advanced triage. The right care at the right time can happen if you invest in advanced instrumentation that allows for insight on structural and functional testing, such as OCT angiography, wide-field photography, electrophysiology, advanced color, and contrast testing. Research confirms that ocular biomarkers of poor health or sight-threatening conditions reveal themselves earlier than previously known.^17-23

Prepare for New Opportunities

Innovations in the pipeline promise to turn prescriptive medical devices, such as smart glasses and other artificial intelligence platforms, into improved precision medicine decision support to best triage patients at higher risk for vision loss or poor health. Additionally, we’ll soon see wearables, such as glasses, transformed into medical devices that will help treat medical conditions, such as migraine headaches, diagnose systemic diseases, such as diabetes, and improve the visual performance of patients.^24,25

Consider Practicing in Areas of Need

Doctor shortages and health care outcomes are not equally distributed in the United States health care centers, and rural communities experience significant doctor and health care worker shortages.² This represents an opportunity for optometrists to support the neediest communities, while practicing at the highest level of acumen. The benefits of rural practice are numerous, including the opportunity to develop deeper patient relationships, greater autonomy, financial incentives, and better work-life balance (read more at Reap the Rewards of Small Town Practice).²⁶

Reap the Rewards of Small Town Practice

Learn about the challenges and rewards of practicing in rural America from Christopher Lopez, OD.

Understand Mega Trends in Health Care

It’s helpful to know how these trends can affect your business, community, and employees, because doctor shortages may be worsened by decreases in physician reimbursement and what seems to be ever-increasing premiums and deductibles. Health insurance companies are incentivized to increase costs. A study by Stanford researchers found that a 4% annual increase in health care costs leads to a 48% increase in health insurance company profits, while a 2% annual increase similarly results in a 22% increase in profits. Their research further revealed that employer and employee contributions for insurance premiums for family coverage increased by 55% and 40% from 2010 to 2020, respectively, effectively regressing wage growth and, slowly, the economy.²⁷ This means that even new doctors struggle to cover costs for student loan debt, child care costs, and living expenses. These facts do not help attract bright new doctors to the workforce.

PRIORITIZE TO ACTUALIZE

Align yourself with resources to solve the health care challenges of our time, including health care worker shortages. This means joining professional societies, seeking out mentors, and committing to ongoing self-education in health care economics, trends, and opportunities. Adhering to the oath we all take as we matriculate into the important position of doctoring is not easy, but with collective effort we can “affirm that the health of my patient will be my first consideration.”²⁸

I want all doctors to be inspired by their own accomplishments and to understand that they have the power to change health care and improve access if they treat patient advocacy, business growth, innovation, adoption, and population health management as imperatives.