Over the next decade, the optometric workforce is projected to experience growth of 1.4% each year, a continued shift toward a female OD majority and a more limited additional capacity for the profession to expand than previously suggested, a recent national survey suggests.1
The investigation, based on 2017 data and published in Optometry and Vision Science, also found a lack of diversity within the profession based on poorly represented minorities, which the authors cite as concerning and a barrier to care. Specifically, only 3.8% of respondents self-identified as Hispanic or Latino, 0.4% as Black/African American and 0.2% as Native American.
“This is clearly much lower than the overall population’s makeup and hopefully is a wake-up call to our profession to encourage minority recruitment,” says optometrist Brian Chou of San Diego.
Researchers distributed the 2017 National Optometry Workforce Survey to roughly 4,000 ODs from the AOA’s database. The results reflected the responses of 1,158 optometrists.
The study found the optometric workforce is projected to annually grow by just 0.6% to 0.7% more than the United States population, and that trend should stay consistent over the next 10 years if no additional optometry programs open.
The investigation also reported some notable shifts compared with similar workforce data reported in 2012 by the Lewin Group that suggested a much higher potential for the then-current workforce to see more patients, as well as a significant disparity in productivity between men and women working in the profession.2
“We found there really weren’t significant differences when we challenged the assumption that the productivity of women wasn’t the same as men, and also, as a profession, we’ve really moved toward a more equitable and balanced workforce,” says lead researcher David A. Heath, OD, EdM, president of the State University of New York College of Optometry.
Women Edge Past Men as Dominant Gender
As more women enter the profession, the workforce continues to experience a shift in the male-to-female ratio, Dr. Heath says.
Female ODs represented 43% of responding doctors in the survey. In 2017, 45% of ODs in the AOA’s database were women (20,249). By January 2020, the number of female optometrists grew to 23,367 (49%). Taking into account that roughly 650 more women now graduate each year from optometry programs—and most retirees currently are male—the authors predict more women than men are now actively practicing optometry in the US.
Additionally, it has commonly been assumed that female ODs work fewer hours than men and see fewer patients; however, the current survey refutes this theory and illustrates an evolving and equitable workforce, the authors note.
|For optometry, the future—and much of the present—is female. Women often make up the lion’s share of graduating classes, as seen here among Berkeley’s 2021 grads (40 female, 13 male), while retirees exiting the field skew heavily male. The 2017 National Optometry Workforce Survey documents female ODs’ gains both in sheer numbers and also hours worked and patients seen.|
Looking at weekly work schedules, women and men logged about the same number of hours: 37.5 for women vs. 38.9 for men. This difference wasn’t significant and is notably smaller than the difference reported in the Lewin study (women: 38.55 hours; men: 42.15).
Similarly, the gender gap narrowed a bit in the number of weeks worked per year. In 2017, women reported working an average of 47.7 weeks while men worked 48.5 weeks annually. In the 2012 Lewin study, women reported working about 46.7 weeks a year vs. 47.8 weeks a year for men.
Considering productivity, women and men both saw essentially the same number of patients per hour: 1.97 for women vs. two for men. This is in contrast to the Lewin study, which reported decreased productivity in women based on patients they saw per hour: 1.63 for women vs. 1.89 for men.
In 2017, 77% of women and 78% of men reported they would prefer to have the same or fewer patient care hours. However, there was an increase in the number of women who desired to decrease hours, from 10% in 2012 to 25% in 2017.
Also of note in gender trends: women tended to be employed rather than self-employed and earned less as a whole.
Overall, a slight majority of optometrists reported income between $100,000 and $199,999, with more female optometrists than male making less than $100,000. Perhaps not surprisingly, those ODs who made more than $200,000 were most likely to be self-employed (23%).
One reason for the apparent salary differences between genders may simply be that male responders tended to be older, more experienced and owned their practices, Dr. Heath says.
Both male and female ODs also appeared to be equally happy with their jobs. Career options/professional growth satisfaction ranked in at 65% for both male and female ODs.
“Throughout our profession, entering class profiles are approximately 70% female, and have been for several years now,” says optometrist Chris Wroten, partner at the Bond-Wroten Eye Clinics in Louisiana and adjunct professor at Southern College of Optometry. "As a result, more and more female doctors of optometry are thankfully sharing their leadership skills by assuming prominent roles in their state associations and within the AOA and other optometric organizations.
Dr. Wroten served as an expert panel member for the 2012 AOA/ASCO Eyecare Workforce Study and is currently the moderator of the AOA’s Presidents Council meetings, president of the Louisiana State Board of Optometry Examiners and Chair of SCO’s Board of Trustees. He also supervises his practice’s primary care and ocular disease residency program and works with student externs.
In his numerous roles in the profession, Dr. Wroten believes optometry is following the same trend as medicine and dentistry—the gender pay gap still exists but is showing signs of closing, while more and more women, and fewer men, are applying to medical, dental and optometry school.
“The women in our profession I’ve been blessed to know and work with are all extremely passionate about optometry, care deeply for their patients, have an unsurpassed work ethic and see every bit as many patients as their male counterparts, while still striking an appropriate work-life balance,” says Dr. Wroten, who works with several female doctors of optometry at his practice, including his wife.
Additional “Capacity” Questioned
Respondents were also asked to assess their ability to take on more patients in their practice, which was defined as “additional capacity.”
The Lewin study reported that optometrists could, on average, see about 20 more patients a week, or 32% more patients annually. In 2012, this finding fed controversy about whether there was a need for more optometrists and more optometry schools, and essentially split the profession into two camps over the issue, Dr. Heath says.
Dr. Chou remembers the impact of the Lewin study and how the results instigated a heated discussion in the profession on whether there were too many optometry schools minting too many ODs.
This latest workforce survey’s growth findings of 1.4% annually (0.6 to 0.7% greater than the U.S. population) suggests an adequate workforce supply, with a small surplus created each year, Dr. Chou suggests.
“This is contrary to the doom-and-gloom scenario of too many optometry schools and too many optometry graduates,” Dr. Chou adds. However, these workforce surveys did not consider technological advances that may reduce consumer demand of traditional optometric services, Dr. Chou suggests.
“For example, there is a proliferation of self-administered online vision tests with remote eyeglass and contact lens prescription renewal,” Dr. Chou notes. “If optometric refractive services erode without the corresponding expansion into other services like medical eye care, our profession can still find itself with far too many optometrists and not enough patients seeking care, irrespective of what the latest workforce survey says.”
The Lewin survey’s question on this topic was effectively appointment book-based, reflecting the sum of the empty slots and the number of no-shows in an OD’s appointment book, Dr. Heath explains. “Since some optometrists may add more appointments to compensate for no-shows—and there will always be no-shows—the 32% figure was an inflated estimate,” he adds. There was also no exploration as to whether the responders wanted to see more patients. As such, the current study asked the question differently, by querying ODs on how many more patient exams they could accommodate without changing current schedules or staffing. To further validate this, the study then queried participants about waiting times for appointments and whether ODs actually wanted to see more patients.
Overall, the mean number of additional patients that reportedly could be seen by an individual provider was pegged at 9.67 per week. This number conceptually represents the additional capacity that an optometrist could see as opposed to would likely see, researchers noted. The new data indicate a likely range of additional patient capacity of 2.29 to 2.57 patients per week (5.05 to 5.65 million annually profession-wide).
The study also considered if doctors who reported they could accommodate additional patients could do so without changing their practice patterns. A total of 65% of ODs reported a wait of at least two days for a patient to get an appointment for a comprehensive eye examination, whereas 7% reported a waiting time of two-to-three weeks and 5% indicated a wait time of more than three weeks.
Nearly two-thirds of ODs reported that their current wait times for appointments were the same as they were the previous year. Only 13% of practicing optometrists reported a decrease in appointment wait times, whereas 23% reported increased wait times.
A final question assessing the ability of the optometrist to see additional patients, asked respondents to indicate if they were unable to accommodate all patients requesting appointments, provide care to all who requested appointments but were overworked, provide care to all who requested appointments (not overworked), or could accommodate more patient appointments.
Eighty-four respondents (8%) indicated they were unable to accommodate all patients asking for an appointment, whereas 12% (133) indicated they did provide services to all patients but were overworked. Notably, only one-third (33%) of respondents selected could accommodate more patient appointments.
Most optometrists within each group indicated they wanted their patient care hours and their non–patient care hours to remain unchanged (49% and 57%, respectively). Less than a third of optometrists in each group indicated a desire to increase patient care hours.
“I do think there are still opportunities to provide more medical eye care and for many of us to better utilize our staffs in the provision of care,” Dr. Wroten suggests.
Another area to consider: New technology may enhance efficiency, but in turn, could also erode some traditional modes of practice.
“However, I don’t get the impression that the demand for optometry services far exceeds the supply of optometrists, except in more rural areas where it’s becoming harder and harder to recruit new graduates to practice,” Dr. Wroten explains.
Additionally, the national applicant pool for optometry school has remained relatively flat for several years now, while the number of optometry school positions available has grown as some existing institutions increase class sizes and newer schools open.
“A host of factors, including the impacts of telemedicine, emerging technologies, and the average retirement age for doctors of optometry, coupled with the quality and quantity of optometry school graduates, will ultimately determine whether demand exceeds supply or vice versa,” Dr. Wroten says.
A Trend Toward More Employed ODs
The current study examined employed vs. self-employed optometrists, broadly defining those who earn a salary as “employed” and not limiting the designation to those who work in a commercial practice. For example, employed optometrists could work in a university setting, a hospital, community health center or in a private optometry or ophthalmology practice, Dr. Heath says.
The most significant finding in this area was a substantial shift in the percentage of employed optometrists, which increased from 29% in 2012 to 44% in 2017.
There was, of course, a commensurate decrease in the percentage of self-employed optometrists from 71% to 56% in 2017, Dr. Heath says.
Dr. Chou finds it concerning—but also not surprising—that there is a trend toward employed vs. self-employed work settings.
“With private equity activity ramping up significantly since 2017 when the latest survey was collected, we can expect an even greater number of ODs finding themselves in employed situations as time moves forward,” Dr. Chou says. “While there are multiple interpretations of what underlies the trend toward employment, my take is that it is increasingly difficult to own a practice, which leads to more aspiring for employment.”
Both studies generally found employed and self-employed optometrists worked the same number of hours, were equally productive and satisfied in their roles.
However, the employed optometrists saw significantly more patients per week on average than those who were self-employed (58 vs. 54).
The trend toward an increasing number of employed optometrists is also mirroring what is occurring in other health care specialties, as large health care systems expand and private equity acquires more practices and employs their previous owners, Dr. Wroten suggests.
“It also seems like a higher percentage of recent optometry school graduates are content to seek an employment relationship vs. purchasing an existing practice or starting one from scratch, some of which may be driven by escalating student debt,” he says.
The opportunities for ODs to work for industry has also increased, Dr. Wroten explains.
Dr. Heath says he believes it’s critically important for the profession to continuously monitor the optometric workforce for not only overall supply and demographic shifts but also for trends that impact national, state and local health care policy. The lack of publications in peer-reviewed journals addressing these issues is startling and puts the profession at a significant disadvantage in its ability to advocate for and affect public health policy, he adds.
1. Heath DA, Spangler JS, Wingert TA, et al. 2017 national optometry workforce survey. Optom Vis Sci. 2021;98(5):500-511.
2. Lewin Group. Report on the 2012 National Eye Care Workforce Survey of Optometrists. Falls Church, VA: The Lewin Group; 2014.