Frustration is mounting among physicians across all specialties, and ophthalmologists are no exception. Increasing regulatory demands, reimbursement challenges, and workforce shortages are driving many to retire early or reduce clinical hours. A convergence of these trends points to a looming deficit in care delivery; some estimates forecast a shortfall of up to 30% in core specialties by 2035.1 As the population ages and care needs escalate, the supply of trained professionals is falling critically short of demand (for more on this topic, see “The Literature”).
These structural pressures are inevitably becoming apparent at the individual level. Ophthalmologists who are stretched clinically are also confronting a quieter strain: the challenge of maintaining professional purpose in a system increasingly defined by volume, metrics, and constraints.
This issue of CRST examines what it takes to continue showing up—not just physically but also psychologically—under these conditions. When institutional support is limited, what keeps us motivated, engaged, and aligned with our work?
In various work settings, I have noticed one need emerge: the need for meaning beyond metrics. Job satisfaction tends to improve when we feel our efforts contribute to something more tangible than improving procedural throughput. That sense of relevance—to patients, to teams, to the broader mission—can help anchor our motivation amid instability.
The pressures of daily practice—complex cases, limited staffing, shifting regulatory protocols, busy schedules—can create a sense of isolation. Sharing experiences with passionate colleagues offers an opportunity to reconnect with the foundational mission of ophthalmology: improving our patients’ vision and their lives.
Medical mission work often highlights this dynamic. Although the intent is to offer care, many of us return with a new perspective. Volunteer and mission work tends to strip away distractions and focus our attention on why our work matters and for whom. It is the simplest form of providing care, with a direct and immediate connection from need to skill to improved function. It offers all of the joy of care delivery without the administrative hassle.
Vision is deeply linked to quality of life. Restoring or preserving sight alters the patient’s trajectory—socially, emotionally, and economically—and affects the likelihood of falls and dementia.2,3 The daily pressures of practice can obscure that reality.
This month’s cover focus encourages readers to reflect not only on disparities in global eye care but also on a quieter, internal deficit: the erosion of professional purpose. In working to close the gap for others, we can often restore something essential in ourselves.
Cathleen M. McCabe, MD
Chief Medical Editor
1. Kuo J, McDonagh C. Trends in ophthalmology practice. EyeNet Magazine. May 1, 2022. Accessed June 2, 2025. https://www.aao.org/eyenet/article/trends-in-ophthalmology-practice
2. Dhital A, Pey T, Stanford M. Visual loss and falls: a review. Eye (Lond). 2010;24(9):1449-1456.
3. Killeen OJ, Zhou Y, Ehrlich JR. Objectively measured visual impairment and dementia prevalence in older adults in the US. JAMA Ophthalmol. 2023;141(4):315-322.
