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Up Front | Nov/Dec 2012

Chief Medical Editor’s Page

A Perfect Storm

Walk out into your waiting room, and look around. How many full chairs do you see? How many empty ones? Could you handle two to three times the number of patients currently present? That is exactly what could happen to ophthalmology practices nationwide, owing to a rare combination of conditions, a “perfect storm,” if you will.

As the baby boomers age, the number of people over the age of 65—prime cataract age these days— increases dramatically. Already, more Americans are older than 65 years of age than at any other time in this nation's history. In January 2011, the first baby boomers hit this milestone, and now, more than 10,000 reach this age per day. The number of Americans over the age of 65 is projected to double by 2019.1 In other words, even if you only maintain your current share of the market, your cataract volume will double.

Baby boomers will not tolerate poor vision as willingly as their parents. They will not “go gentle into that good night.” They view aging as weakness. They have the money and will seek cataract surgery earlier than their parents did.

Other factors are at play as well. Novel technologies such as presbyopia-correcting IOLs and femtosecond lasers will likely push the age for cataract surgery lower. As our comfort with lens removal surgery has increased, the number of our patients having surgery for “dysfunctional lenses” or high refractive errors has also risen. Decreasing the average age of surgery is a onetime event, like clear-cutting a forest, but that is irrelevant, because the process is happening in our lifetime.

There will be fewer doctors to handle the increase in volume. Our number is closely controlled by federal funding to medical schools and the health care budget, neither of which is likely to grow. Even if new residency slots opened in 2013, it would take 7 years for the first surgeon to emerge from the pipeline. We cannot wait that long. Plus, various surveys indicate we ophthalmologists are looking for more time out of the office, not in it. More and more women are becoming ophthalmologists, a very good thing for our profession, but how many will want to maintain their careers if they become parents? Reportedly, only 33% of US women want to work full time after they become mothers versus 78% of men who become fathers.2 In addition, doctors are retiring earlier than in the past.

Those of us who will still be practicing in 2019 should heed these statistics. We should buy more chairs.

  1. Brandon E. 65-and-older population soars. US News and World Report. http://money.usnews.com/ money/retirement/articles/2012/01/09/65-and-older-population-soars. Published January 9, 2012. Accessed October 10, 2012.
  2. Grose J. Why do so few mothers want to work full-time? Slate. http://www.slate.com/blogs/ xx_factor/2011/12/13/national_marriage_project_a_new_report_shows_that_a_majority_ of_mothers_don_t_want_full_time_work.html. Posted December 13, 2011. Accessed October 10, 2012.
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