NEWYORK - Workforce Study

7/28/2019 NEWYORK - Workforce Study

1/10

O R I G I N A L P A P E R

The New York State Optometry Workforce Study

Mort Soroka

Published online: 30 August 2011

Springer Science+Business Media, LLC 2011

Abstract This study presents an analysis of the current

optometry workforce, both as a unique profession and morebroadly within the context of all eye care providers

(optometry and ophthalmology) in New York State. The

supply and distribution of eye care practitioners provides

useful information for policy makers while providing

insights as to the impact of the one optometry school within

the state. Several databases were employed and a web

based survey was developed for completion by all

optometrists. The questionnaire included demographic

data, whether they were actively practicing in New York

State or any other state, were they full time or part time,

their primary mode of practice, or if they provided care

within institutional settings. Access to care was gauged by

the respondents availability for appointments during eve-

nings or weekends. Access to eye care services in New

York State has improved significantly during the past

30 years as the supply of optometrists increased. Before

this study was conducted it was generally believed that

there were more optometrists than ophthalmologists in

every state of the nation except New York, Maryland and

the District of Columbia. Findings of this study demon-

strate there are 37% more optometrists in New York State

than ophthalmologists and more evenly distributed as

optometrists are located in almost every county of the state.

Sixteen counties have no ophthalmologists. This is attrib-

uted to the presence of the College of Optometry estab-

lished in 1971. More than 60% of all optometrists in the

state are SUNY College of Optometry graduates.

Keywords Workforce Optometry Ophthalmology

Supply eye care providers

Introduction

Workforce requirements are determined by a complex set

of interacting factors including demographics of the pop-

ulation, the existing supply of providers, epidemiological

factors, insurance coverage, third party plans, new tech-

nology, regulatory actions and legislative developments.

The dynamics affecting the supply of provider and the

demand for eye care services is important both for the

profession and for the communities they serve. To get a

better understanding of these forces, we need a detailed

understanding of current numbers and distribution of pro-

viders. Reliable numbers of practicing optometrists are

unavailable. Demographic profiles of eye care practitioners

are absent and detailed statistics on the modes of practice

and the services they provide are inconsistent. Planning for

optometry, the third largest among independent health

professionals, and for the communities they serve, is dif-

ficult without definitive information. As the nation trans-

forms its health delivery system under health reform, it is

increasingly important to gather information that accu-

rately describes the current supply of eye care providers.

In the United States, the licensure of health care per-

sonnel traditionally has been the responsibility of the state

licensing boards, governed by licensing statutes and

enacted by the state. Although statistics on the supply of

health providers are available from state licensing agen-

cies, the accuracy of this data is questionable. Although

some states impose an annual re-licensure requirement,

other states maintain a 3-year process with little or no

M. Soroka (&)

Center for Vision Care Policy, State University of New York

College of Optometry, 33 West 42 Street, New York, NY 10036,

USA

e-mail: [email protected]

123

J Community Health (2012) 37:448457

DOI 10.1007/s10900-011-9462-7


2/10

updates during the intervening period. As a result, state

licensing agencies invariably consider registered optome-

trists as active providers even when they are retired,

deceased or only work in other states.

Other databases on optometry have been found to be

deficient for a variety of reasons Registries from the

American Optometric Association include only dues-pay-

ing members of the professional organization. The BlueBook of Optometry, a privately published directory relies

on those who choose to be included and lacks a mechanism

to delete inactive providers. Newly licensed practitioners

are not automatically listed unless they submit their names

for inclusion. The absence of a reliable database on

optometrists provided a compelling need to undertake a

census of optometrists in New York State.

This study provides a comprehensive census of optom-

etrists in the State of New York and presents an analysis of

the current optometry workforce in New York; data that

may provide useful information for policy makers at pro-

fessional optometry organizations, governmental agencies,Medicare and Medicaid, third party carriers, insurance

companies, vision plans, preferred provider organizations

(PPOs), HMOs, the SUNY College of Optometry. This

report also incorporates critical findings on the supply of

ophthalmologists in New York, providing a comprehensive

understanding of eye care providers state-wide.

As the only optometry school in the state, and one that is

supported by state funds, New York State through the

College of Optometry of the State University of New York

has made a considerable investment in training new

optometrists. This study was designed to determine, in part,

the extent to which the College of Optometry has con-

tributed to the optometry workforce within the state.

Methods

Optometry

A detailed assessment of existing optometry databases was

undertaken. The Blue Book of Optometrists (2010 edition)

had a total of 1,233 optometrists located in 356 cities/towns

and subsections in New York. As a resource, the Blue Book

was found to be an inaccurate and unreliable source. The

number of optometrists within the Blue Book is signifi-

cantly less than all other sources, a direct result of inherent

shortcomings of this directory. They do not work with any

organization nor do they make any attempt to obtain a list

of registered optometrists from the states licensing agency

(T. Guadagnino, personal communication). Although they

publicize their directory and encourage doctors to submit

their names for inclusion, additions and deletions to the

Bluebook are at the discretion of the provider. Deceased or

retired optometrists were found listed on the Bluebook long

after the doctor ceased to practice.

The Yellow Pages was also a poor data source since

many providers who are employed by another optometrist,

ophthalmologist or optical establishment are not listed

under their own names. Furthermore, individual providers

or optometrists belonging to a group practice may be listed

under a name different from their own. Single listings mayrepresent more than one practitioner. Since patients no

longer use the Yellow Pages to find practitioner as they had

in the past, providers seeking to maximize their advertising

budgets no longer see the Yellow Pages as a source of

referrals and are increasingly reluctant to advertise.

A survey was developed to determine the number of

practicing optometrists in New York State in the year 2010.

Our database for optometry was compiled from several

sources. New York States Freedom of Information Law

(FOIL, Public Officers Law 87) allows members of the

public to access records of governmental agencies. The

electronic file of all registered optometrists obtained fromNew York State Department of Education (NYSED) was

converted into an excel file. However, this list contained

only the name, license number and county for each

optometrist. The New York State Office of the Professions

database contains only one address of record for each

licensed provider, and is unable to distinguish a licensees

business address from a residential or mailing address. For

this reason they do not provide the providers full address

to the public as it would be an invasion of the licensees

privacy. The list from the State Education Department

included the providers name, license number, status of

license, the city and state portion of their address (no zip

codes, or street addresses), date of licensure, registration

expiration date, indication of any disciplinary action, and

the school name and the date the degree was obtained. The

department does not maintain records of e-mail addresses

or telephone numbers.

An effort was made to reach all optometrists, those self

employed in private practice, group practice or employed

by other practitioners or within institutional settings or

commercial or optical establishments. Employed optome-

trists; especially those who work part time within multiple

optical establishments, are frequently under reported in

workforce studies. Often, these providers are not members

of professional associations (i.e. the American Optometric

Association or the New York State Optometric Associa-

tion) and may therefore be under-represented in studies.

Strategies to locate these practitioners were developed. A

request to several third party vision plans for a directory of

their participating providers was sent to Vision Service

Plan (VSP), EyeMed and Davis Vision. Although VSP

panel doctors are all in private practice, participating

optometrists within EyeMed and Davis Vision include

J Community Health (2012) 37:448457 449

123


3/10

those who are employed by corporate and franchised

optical establishments and optical chains. In seeking

cooperation from these vision plans, proprietary and con-

fidential concerns were raised. While the vision plans did

not directly release their providers names, they all con-

sented to send our workforce survey on our behalf to their

members using e-mail addresses. Additionally, e-mail

addresses from the New York State Optometric Associa-tion, the Optometric Society of the City of New York and

the SUNY College of Optometry were obtained. Many

provider databases lack e-mail addresses and when avail-

able, many entries are no longer current.

A web-based survey was constructed that enabled

optometrists to respond electronically. The instrument was

pre-tested by a small group of optometrists and was revised

for content validity and clarity. The survey requested

demographic data and included an additional 15 questions,

primarily multiple choice and yes or no questions. Com-

pletion of the survey took approximately 10 min. The

following link was accessed by all those responding tothe survey electronically. http://www.sunyopt.edu/cgi-bin/

Scripts/rws3.pl?FORM=WorkforceStudy.

Notices were e-mailed and included in the newsletter of

the Optometric Society of New York and all other local

optometry societies in New York State. Letters and

announcements from the Presidents of these local societies

encouraged everyone to access the link to the survey. The

questionnaire included demographic data on the practi-

tioner, whether they were in active practice in New York

State or any other state, were they full time or part time

(fewer than 25 h), their primary mode of practice, if they

provided care within any institutional settings, their

retirement plans, intentions of hiring an associate, and

whether they provided care in the evenings or weekends.

Although we requested license number, when not provided,

we were able to access this information directly from the

states database.

Responses were matched with the New York State

Education Department listing to determine non-respon-

dents. These names were circulated among Presidents of

local optometry societies, the Alumni office of SUNY

College of Optometry and other leaders within the pro-

fession requesting any contacts they may have of these

practitioners or knowledge of their status in New York

State. Search engines were also employed to identify the

addresses and telephone numbers of non-respondents listed

on the NYSED database who had not completed the

survey.

This approach enabled direct contact by telephone and

mailings to additional providers. When telephone contact

was made we attempted to obtain completion of the survey

over the phone and subsequently accessed the website for

input. Otherwise, we directed the respondents to the link

for input directly by the individual. Often, the phone

numbers represented the doctors residence and messages

were left when possible. When all else failed, direct

mailings were sent to all remaining non-respondents.

Providers were cautioned that they may have received

the survey from multiple sources and that they should

complete it only once. Whenever multiple forms werereceived, we eliminated the duplicate surveys. This report

focuses on the findings of an optometry survey conducted

between May and October 2010.

Ophthalmology

The American Board of Medical Specialties (ABMS)

Directory of Board Certified Medical Specialists 2010

(42nd edition) was used to determine the current number

of New York State ophthalmologists. All providers were

listed by location; with a total of 321 cities/towns, villages

and subsections. The Red Book of Ophthalmologists 2010was also used to compare the number of ophthalmologists

with the ABMS Directory. Ophthalmologists within this

directory were listed in 619 villages, cities or neighbor-

hoods. To enable comparative review with the NYSED

database, we collapsed all entries from the ABMS and Red

Book directories into the 62 counties of New York State.

We converted all towns and cities into counties using the

website NY HomeTown Locator which identifies the spe-

cific counties for all locations. With a zip code the county

can be determined from the following website: http://

newyork.areaconnect.com/zip2.htm. Provider data in oph-

thalmology was also obtained from the Annual New York

Physician Workforce Profile, 2009 Edition [1].

Results

The number of New York optometrists listed on the New

York State Educational Department website (http://www.op.

nysed.gov/prof/optom/optomcounts.htm) is 3,049. License

statistics reported by the Office of the Professions represent

only currently registered optometrists. Inactive or non-

registered are not counted. When a professional informs the

Department at the time of reregistration that he or she is not

practicing in New York, the record is marked inactive. If

a registration has lapsed without explanation, the record is

classified as not registered. When the Department has

received reliable notice of the death of a licensee, that

record is marked deceased. Licenses that are currently

suspended, revoked, or have been surrendered pursuant to

disciplinary action, are marked accordingly and are not

included in the count.

450 J Community Health (2012) 37:448457

123
http://www.sunyopt.edu/cgi-bin/Scripts/rws3.pl?FORM=WorkforceStudyhttp://www.sunyopt.edu/cgi-bin/Scripts/rws3.pl?FORM=WorkforceStudyhttp://newyork.areaconnect.com/zip2.htmhttp://newyork.areaconnect.com/zip2.htmhttp://www.op.nysed.gov/prof/optom/optomcounts.htmhttp://www.op.nysed.gov/prof/optom/optomcounts.htmhttp://www.op.nysed.gov/prof/optom/optomcounts.htmhttp://www.op.nysed.gov/prof/optom/optomcounts.htmhttp://newyork.areaconnect.com/zip2.htmhttp://newyork.areaconnect.com/zip2.htmhttp://www.sunyopt.edu/cgi-bin/Scripts/rws3.pl?FORM=WorkforceStudyhttp://www.sunyopt.edu/cgi-bin/Scripts/rws3.pl?FORM=WorkforceStudy


4/10

Among 3,049 optometrists currently registered and

licensed in New York State, 560 of these optometrists are

active only in other states (538) and countries (22) as

reported to the State Education Department. The remaining

2,489 optometrists are listed geographically by county.

Surveys were sent to these optometrists to determine

whether and where they practice in New York State. The

Optometry Workforce Census identified a total of 2,126*registered and active optometrists in New York State

(Table 1). Respondents included those who completed the

survey on-line, by phone or through a mailed-in survey. A

number of providers had responded more than once and

these duplicates were removed. In addition, all non-reg-

istered optometrists, and retired optometrists and pro-

viders who no longer practiced in New York were also

eliminated. Among the registered 2,489 optometrists New

York State we found an additional 120 individuals who

responded to the survey and informed us that they were

retired or no longer in practice in New York State. The

overall response rate to our survey was therefore 90.2%. Ofthe remaining 243 non-respondents, it is conceivable that a

significant percentage are in active practice and the supply

of optometrists may be as much as 2,247 (assuming only

50% of the non-respondents are in practice). For the pur-

poses of this study, however, we will use the number of

2,126 active optometrists.

Our maps and tables reflect the respondents office

location indicated on the survey forms when this infor-

mation was provided. Otherwise we used the NYSED

county information. Because county information con-

tained on the NYSED database may be the actual practice

location, the licensees home address, or merely a mailing

address, there may be a slight misrepresentation of the

distribution of optometrists in the state by county. The

supply of optometrists differs by region when calculating

ratios of optometrists to population; whereby a mal-dis-

tribution of optometrists is evident. The most marked

shortage areas were rural upstate counties. A number of

urban areas and inner city areas were also found to lack

adequate eye care providers. New York City (Brooklyn,

Manhattan, Queens, Staten Island and the Bronx) has 771

optometrists for its 8,391,881 residents (one OD per

10,884 residents (Table 1). This compares to 1,355 prac-

titioners for the rest of the state (population- 11,149,572)

or one optometrist per 8,229 residents. The ratio of

optometrists per population (where there is at least one

optometrist) ranges from one optometrist per 3,884 pop-

ulation (Warren County) to one optometrist per 55,053

(Fulton County).

The number of ophthalmologists in New York listed in

the ABMS Directory of Board Certified Medical Spe-

cialists is 1792. However, 234 of these providers were

identified as being inactive or not registered after cross

checking the directory in the NYSED website to deter-

mine their current status. The total number of ophthal-

mologists is no more than 1,558 (Table 1). No further

attempt was made to determine whether all other oph-

thalmologists were in active practice. Surveys were not

sent to ophthalmologist to ascertain whether they were in

active practice, thus, this number may be inflated. The

total number of ophthalmologists listed on our tables andmaps are, therefore, overstated. Sixteen counties lack a

single ophthalmologist; thirteen of these counties have at

least one optometrist (Table 1, Fig. 1). In other parts of

the New York State, eye care providers of any type were

in short supply.

Survey Results

Demographic Information

More than 60% of all respondents to the workforce survey

were SUNY College of Optometry graduates. Femalepractitioners in New York are represented by 38% of all

optometrists (Table 2).

Compared to the nation as a whole, New Yorks

population is more racially and ethnically diverse. With

more than 17% of New Yorkers who are Black and an

additional 17% who are Hispanic, the ethnic breakdown

of New Yorks optometrists does not resemble the

demographic characteristics of the states ethnic popula-

tion. Minorities are underrepresented among optometrists

relative to their proportion of the total population

(Table 2). Recruitment efforts should be reinforced to

encourage minorities to enroll in the SUNY College of

Optometry program. Increasing minority representation

among optometrists may improve access to care for

minorities and underserved populations. The use of health

services among non-whites and Hispanics differ to pat-

terns found among white populations. Cultural differences

may account for some of the disparities in use among

ethnic groups. An age distribution of optometrists is

presented in Table 2. The average age of all optometrists

is 45.4 years. The compares to an average age of oph-

thalmologists of 54 years [2].

Retirement, Potential Opportunities

Almost 15% of all optometrists in the state are over

60 years of age. When asked whether you are considering

retirement within 5 years, 15% responded affirmatively.

An outreach initiative should be developed to contact those

practitioners who may retire within the near future. There

may be opportunities where the established practitioner

would consider bringing in a younger colleague and a

potential buyer for their practice. Respondents were asked


123


5/10

Table 1 New York state counties with the number of optometrists and ophthalmologists

County Workforce study:

number of

optometrists

ABMS number

of ophthalmologists

NYSED optometry

*registered licensed

ODs

Population 7/1/9 US census

bureau population division

March 2010

Ratio optometrists to

population (workforce

study figures)

Albany 39 50 47 298,284 1:7,648

Allegany 2 2 3 49,157 1:24,579

Bronx 68 55 51 1,397,287 1:20,548Broome 29 11 27 194,630 1:6,711

Cattaraugus 6 3 7 79,689 1:13,282

Cayuga 3 3 3 79,526 1:26,509

Chautauqua 19 4 18 133,503 1:7,026

Chemung 9 6 11 88,331 1:9,815

Chenango 3 3 4 50,620 1:16,873

Clinton 12 4 12 81,618 1:6,802

Columbia 4 7 4 61,618 1:15,405

Cortland 3 0 6 47,996 1:15,999

Delaware 2 0 2 45,514 1:22,757

Dutchess 33 14 37 293,562 1:8,896

Erie 109 61 120 909,247 1:8,342

Essex 5 0 4 37,686 1:7,537

Franklin 4 0 5 50,274 1:12,569

Fulton 1 2 1 55,053 1:55,053

Genesee 7 2 3 57,868 1:8,267

Greene 6 0 5 48,947 1:8,158

Hamilton 0 0 0 4,923 0

Herkimer 8 0 8 62,236 1:7,780

Jefferson 12 4 12 118,719 1:9,893

Kings 166 115 200 2,567,098 1:15,464

Lewis 0 0 0 26,157 0

Livingston 4 0 5 62,871 1:15,718

Madison 6 0 8 69,954 1:11,659

Monroe 100 60 122 733,703 1:7,337

Montgomery 5 1 7 48,616 1:9,723

Nassau 221 159 312 1,357,429 1:6,142

New York 359 466 295 1,629,054 1:4,538

Niagara 20 9 21 214,557 1:10,728

Oneida 23 12 31 231,044 1:10,045

Onondaga 72 39 78 454,753 1:6,316

Ontario 22 6 14 105,650 1:4,802

Orange 37 11 45 383,532 10,366

Orleans 0 0 0 42,051 0

Oswego 8 2 5 121,377 1:15,172Otsego 10 5 14 61,602 1:6,160

Putnam 11 1 11 99,265 1:9,024

Queens 158 83 254 2,306,712 1:14,599

Rensselaer 9 9 9 155,541 1:17,282

Richmond 20 19 45 491,730 1:24,587

Rockland 51 33 71 300,173 1:5,886

Saratoga 23 7 33 109,715 1:4,770


123


6/10

whether they would be considering an associate in the next

5 years and 14.2% indicated they would.

Optometrists practice in multiple settings, locations and

within a variety of modes of practice (Table 3). They maybe self employed working in private offices or within retail

optical establishments. Although solo, private practice is

the most popular form of practice, employed arrangements

are preferred by one-third of all practitioners. This may be

with another optometrist, ophthalmologist, optician, optical

establishment, school of optometry, or within other insti-

tutional settings. Table 3 demonstrates that while private

solo practice remains the most dominant mode of practice,

many choose alternate forms of practice. Among all pro-

viders almost 40% are in solo private practice with an

additional 15% in associate or group practice. An addi-

tional 12% of optometrists are self employed as owners oftheir franchise or optical establishment. Salaried or cor-

porate practice optometrists employed by an optical chain

or employed by an optician comprised 14% of all optom-

etrists. Employment by an optometrist or an ophthalmol-

ogist represents another 12% of all providers. Similar to

group practice setting, these optometrist works together

with other optometrists and ophthalmologists in what may

be a private practice or medical group setting.

Access

There are more optometrists than ophthalmologists in

New York State. Moreover, optometrists have a pres-ence in almost every county of the state; there are no

ophthalmologists in 16 counties. Since more than one-

third of all optometrists maintain multiple offices, access

to their care is further increased. Factors affecting

access include hours of availability of the eye care

specialist, including evening and weekend hours. Three

quarters of all optometrists reported weekend availabil-

ity and more than half indicated that they have evening

hours (Table 4). Past studies indicate that few ophthal-

mologists have either weekend or evening office hours

[3]. Increased access to optometrists is further rein-

forced by evening and weekend office hours offered bymost optometrists. A recent survey indicates 40% of

eyecare consumers prefer evening/weekend hours.

Commissioned by EyeMed Vision Care, 25% of the

respondents to the survey said they prefer to access to

vision care services on Saturdays at locations with all-

days hours, another 12% said they prefer weekday

evenings after 5 p.m., while 4 percent said they prefer

Sundays [4].

Table 1 continued

County Workforce study:

number of

optometrists

ABMS number

of ophthalmologists

NYSED optometry

*registered licensed

ODs

Population 7/1/9 US census

bureau population division

March 2010

Ratio optometrists to

population (workforce

study figures)

Schenectady 14 6 19 220,069 1:15,719

Schoharie 4 0 3 152,169 1:38,042

Schuyler 1 0 1 31,529 1:31,529Seneca 1 0 2 18,720 1:18,720

St. Lawrence 12 1 14 34,049 1:2,837

Steuben 11 4 8 96,552 1:8,777

Suffolk 175 78 214 1,518,475 1:8,677

Sullivan 4 2 6 75,828 1:18,957

Tioga 5 0 9 50,064 1:10,013

Tompkins 9 3 7 101,779 1:11,309

Ulster 22 9 25 181,440 1:8,247

Warren 17 7 14 66,021 1:3,884

Washington 4 1 3 62,753 1:15,688

Wayne 8 1 14 91,291 1:11,411

Westchester 125 144 174 955,962 1:7,648

Wyoming 4 3 5 41,398 1:10,350

Yates 1 0 2 24,482 1:24,482

Unknown County 41

All Counties 2,126 1,558 2,489 19,541,453 1:9,192

* Number of optometrists who are reported by NYS as practicing out of state and out of the US have been deducted


123


7/10

Residencies

After completing four years of optometry school graduates

may elect to take a 1 year residency offered at SUNY

College of Optometry or at one of 16 other schools of

optometry. Of all practicing optometrists more than 20%

reported taking a residency after graduation. During the

two past years, considerable movement has been made

toward the development of a Board certification process for

the profession. Although there are several organizations

offering board certification, completion of a residency post

optometry school would qualify the optometrist by all

competing board-certifying groups. Nationally, there are

only 300 optometric residency positions accredited by the

Accreditation Council on Optometric Education (ACOE).Increasing the number of residency positions should be

a priority for SUNY College of Optometry, as well as all

other optometry schools.

Discussion

The supply of health providers should keep pace with the

needs of an expanding population. Our census indicates in

Niagara

Erie

Chautauqua Cattaraugus

Orleans

Genesee

Wyoming

Allegany

Monroe

Livingston

Steuben

Wayne

Yates

Ontario

Seneca

Cayuga

Oswego

Onondaga

Cortland

Schuyler

Tompkins

Chemung

Tioga

Jefferson

St. Lawrence

Franklin

Clinton

Essex

Lewis

HerkimerOneida

Madison

Chenango

Broome

HamiltonWarren

Fulton

Montgomery

Otsego

Delaware

Sullivan

Washington

Saratoga

Rensselaer

Columbia

Dutchess

SchoharieAlbany

Greene

Ulster

Schenectady

OrangePutnam

Suffolk

Westchester

Rockland

Nassau

QueensRichmondKings

Bronx

New York

2

0

0

4

6

01

2

0

1

#Optometrists from Workforce Survey

(December 15, 2010)

#Ophthalmologist from ABMS Directory 2010

Counties with no ophthalmologists

Map: Distribution of Eye CareProviders in New York State

0

0

19

4

6

23

61

2

109

20

9

11

4

12

0

1

412

4

12

4

0

8

0

23

12

5

17

7

23

7

12

5 1

22

9

0

3

0

29

11

68; 55

359; 466

20; 19

158; 83

221

159

175

78

33

14

4

37

11

3

3

10

5

8

2

72

3922

6

1000

81

4

3

7 2

6

0

39

50

11; 1

125

144

51; 33

3

3

9

3

01 0

4

9

9

479 6

0

60

4

0

50

0

114

6

166; 115

Fig. 1 Distribution of eye care providers in New York State


123


8/10

New York State there is one optometrist for 9,192 popu-

lation. The American Optometric Association advocated an

optimum ratio of one optometrists for every 7,000 persons

or 14:3 per 100,000 populations [5]. Birchard and Elliot

estimated the percentage of the population having cor-

rectable visual defects and calculated a desirable ratio of

one optometrists per 7,665 population [6]. Optimal ratios

promoted in the past century can not be expected to have

any bearing on present or future needs. Optometry has

changed significantly from a restricted profession where

drugs could not be utilized in their treatment regimen to a

profession that has expanded its scope of practice toincorporate medications to treat and manage eye diseases

short of surgical intervention. Moreover, the prevalence

and incidence of ocular disease has increased substantially

especially with an aging population. Indeed, the American

Optometric Association no longer recommends a specific

ratio (C. Giltinan-Kneip, personal communication).

Previously, studies reported that there were more oph-

thalmologists in New York State than optometrists [7].

Today, our census has determined the supply of optome-

trists in New York exceeds the supply of ophthalmologists

by 37%. This is attributed to the presence of the College of

Optometry and its graduates since 1975. Almost 60% of alloptometrists who practice in New York State are SUNY

Optometry graduates. The schools presence has certainly

been a major factor in providing eyecare services to resi-

dents of the state.

Gender demographics in the profession of optometry are

changing considerably. The percentage of female optom-

etrists in New York State is expected to increase signifi-

cantly in the coming years since the current proportion of

SUNY female graduates exceeds 70%. Women outnumber

males in optometry schools nationwide, as the overall

percentage of female students in professional optometry

schools is 64%. The impact of this demographic shift on

the supply of optometrists can be considerable. Female

health practitioners decrease their work schedules during

childbearing and child rearing years. White estimated that

female optometrists work approximately 5 fewer hours per

week than their male counterparts [8]. Lee concluded that

female ophthalmologists reduce their full term equivalency

by 15% as compared to male physicians [9]. Female pro-

viders are more likely to work part-time and take time to

have a family with extended family leave time. In addition,

Table 2 Demographic characteristics of NYS optometrists

Frequency Percent

Sex

Male 1,275 61.7

Female 791 38.3

Total 2,066 100

Ethnicity

Caucasian 1,417 81.2

African/American 30 1.7

Hispanic 34 1.9

Asian 223 12.8

Other 42 2.4

Total 1,746 100.0

Age

2029 years 79 4.4

3039 years 492 27.3

4049 years 468 26.0

5059 years 498 27.7

6069 years 193 10.77

70 years and older 69 3.8

All age groups 1,799 100.0

Table 3 Mode of practice: NYS Optometrists

Primary mode of practice Number Percent

Self employed 1,179 66.0

Private solo practice 699 39.1

Associate Practice 68 3.8

Group Practice 191 10.7Optical establishment 221 12.4

Employed 607 34.0

Optical chain 154 8.6

Optician 105 5.9

Optometrist 117 6.6

Ophthalmologist 92 5.2

Hospital 31 1.7

Clinic/school 54 3.0

Other 54 3.0

Total 1,786 100.0

Table 4 Accessibility

Number Percent

Weekend availability (Saturday or Sunday)

Yes 1,364 74.9

No 457 25.1

Total 1,821 100.0

Evening office hours (after 6 PM)

Yes 977 54.0

No 832 46.0

Total 1,809 100.0

Practice in multiple locations

Yes 621 37.7

No 1,027 62.3

Total 1,648 100.0


123


9/10

modes of practice and retirement patterns differ for female

practitioners.

Employed Opportunities

Changes in the business of health care are causing many

health providers to seek employed opportunities rather than

self employment in private or group practice settings [10].Economic pressures faced by newly graduating optome-

trists range from decreased private and government reim-

bursements to rising health costs associated with private

practice. Health reform could dramatically change the way

providers get paid, also causing newly licensed optome-

trists to seek employment opportunities. Independent pro-

viders will have to invest heavily in new equipment and

instrumentation in addition to computerized medical record

systems and electronic prescriptions to meet government

programs and initiations. The demographics of the work-

force, with an emerging female emphasis, may also play a

role in this development. To some extent there may bemore security and part time prospects in employed settings.

Optometry schools should recognize that these career paths

differ from its previous generation. Changes in curriculum

and awareness of these developing trends by the profession

are important.

The trend toward employment is endemic within the

health profession including optometry. A substantial shift

is apparent as more optometrists are either leaving solo

practice or entering the profession accepting employed

arrangements. More than one-third of all optometrists

reported that their primary mode of practice was as an

employee. A census of optometrists in 1973 found only

19% of all optometrists were employed with 61.5% in solo

practice [11]. Only 39% of all practitioners are in private

solo practice today. The single largest category of salaried

optometrists is those employed by an optical corporation or

an optician, accounting for 14% of all optometrists.

Increasingly, younger optometrists are seeking careers

within retail centers such as Walmart, Costco, Sears, Pearle

Vision, and LensCrafters. Surveys of recent optometry

graduates indicate that these modes of practice choices may

be short term decisions as younger practitioners struggle

with student loans and a desire to enter the workforce.

Future surveys will have to study whether career changes

are made once the doctor becomes more established in their

professional roles. As an alternative to employment by a

retail center, some optometrists may simply choose to rent

space from them. This may be dictated by state law and

side by side practices are common. When permitted,

employment may be preferred because it frees the optom-

etrist from the extensive costs to establish a private practice

of their own and from the administrative and business

aspects of a practice. A recent study on retail health clinics

determined that they offer readily accessible, cost effective

and high quality care, for a relatively limited set of basic

health care services. Although the study focused on the

care of physician-owned health centers operating in New

York State in retail stores such as Duane Reade and CVS,

this may also be the case for eye care rendered in retail

optical establishments [12].

The opportunities open to recent graduates and the typeof practices that they join upon graduation are realities that

should be considered by professional schools. Career

planning and advising offices must be cognizant of the

practice patterns that are developing with changes in the

health care delivery system. Irrespective of the desire of the

school in preferring certain modes of practice, recognition

must be made that significant numbers may seek employ-

ment opportunities within corporate establishments or

within offices of ophthalmologists. In addition, programs

should be encouraged and opportunities identified that

make partnership or group practice a viable option for

young graduates.Databases for eye care providers must be improved.

The Blue Book of Optometrists and the Red Book of

Ophthalmologists are poor resources on the number and

the distribution of practicing eye care practitioners.

Similarly, the Yellow Pages does not list the names of

employed optometrists within their directory. Moreover,

many providers refuse to advertise or be included. State

licensing data maintained by the New York State office

of Professional Discipline also contains outdated infor-

mation. Licensure recertification every 3 years is partially

responsible for this. However, practitioners who are

currently licensed and practicing in other states are still

listed and inflate the numbers of active providers within

the state.

Forecasting the supply requirements of eye care pro-

viders is a difficult and complex endeavor. Future needs

are, in part, determined by the present supply. One must

be cautious in using certain databases in determining the

current supply. Licensing statistics maintained by state

licensing agencies are dependent on self-reporting chan-

ges during the interval of the relicensing process. Newly

licensed individuals may also be practicing in other

states and may not reflect an actual increase in that

states supply. Unless licensing boards collect detailed

profiles on practice locations, hours devoted to patient

activities, an accurate number on the supply of practi-

tioners will be compromised. Licensing agencies and

state boards of optometry should consider annual surveys

of all licensees so that better forecasts and planning can

be performed.

Declaring specific geographic areas as shortage areas

may be over simplistic, since adjacent counties that have an

ample supply of eyecare providers may be accessed by


123


10/10

patients. Furthermore, individuals often receive care not

only where they reside, but also near their place of

employment.

Limitations

Practice location was determined by the providers primary

site. Apportioning providers to defined geographic areasmay be misrepresented especially when members of a

provider group are in multiple offices and various settings

that may in fact be located in different counties. Many

optometrists are not fulltime in a single office setting but

rather practice in several locations often in different prac-

tice modes. More than one-third of all optometrists repor-

ted practicing in multiple locations and offices. We also

recognize that the number of ophthalmologists may be

inflated since we did not survey all entries contained within

the ABMS Directory.

Conflict of interest Author disclosed no conflicts of interest.

References

1. Armstrong, D. P., & Forte, G. J. (2010) Annual New York Phy-

sician Workforce Profile, 2010 Edition. Rensselaer, NY: Center

for Health Workforce Studies, School of Public Health, SUNY

Albany.

2. Association of American Medical Colleges Center for Workforce

Studies. (2008). 2008 Physician Specialty Data.

3. Soroka, M. (1991). Comparison of exam fees and availability of

routine eye care by optometrists and ophthalmologists. Public

Health Reports 106(4).

4. Williams, M. (2010). Many consumers prefer evening and

weekend hours for vision care services. EyeMed Vision Care.

5. Pennell, M. Y., & Delong, M. B. (1970). Optometric education

and manpower. Journal of American Optometric Association, 41,

841956.

6. Birchard, C. L., & Elliot, T. F. (1967). A re-evaluation of the ratio

of optometrists to population in the United States in light of the

socio-economic trends in health care. American Journal of

Optometry and Archives of American Academy of Optometry,

44(3), 168182.

7. White, A. F., White, C., & Dokson, T. (2000). Workforce study of

optometrists (pp. 110111). Cambridge, Mass: Abt Associates

Inc.

8. White, A. J., Doksum, T., & White, C. (2000). Workforce pro-

jections for optometry. Optometry, 71, 284300.

9. Lee, P. L., Jackson, C. A., & Relles, D. A. (1995). Eye care

workforce supply and requirements. Ophthalmology, 102,

19641972.

10. Liebhaber, A., & Grossman, J. M. (2007). Physicians moving to

mid-sized, single-specialty practices. Center for Studying Health

System Change Tracking Report 18.

11. Redmond, D. W., Alten, J. R., & Berstein, S. (1973). Optometric

manpower resources. Journal of American Optometric Associa-

tion, 46, 801806.

12. Howard, P. (2011). East access, quality care: The role for retail

health clinics in New York. Center for Medical Progress Report

12. Manhattan Institute.


123

Documents

NEWYORK - Workforce Study