By examining the geographic distribution of ophthalmic subspecialist surgeons in the United States, this study revealed significant disparities in access to specialized care between urban and rural populations.
The cross-sectional population-based study analyzed Medicare Fee-for-Service claims from 2012 to 2022 for patients aged 65 and older who underwent subspecialized ophthalmic procedures, including cornea, glaucoma, oculoplastic, retina, and strabismus surgery. The study included 13,526 surgeons (72.6% male and 26.8% female), 30% of whom specialized in retina, while 26.8% specialized in glaucoma, 18.5% specialized in cornea, 14.2% specialized in oculoplastics, and 9% specialized in strabismus.
In their JAMA Ophthamology article, the investigators described the “growing urban-rural gap among primary care physicians” as well as the “general surgeons in rural communities [who]…perform specialized procedures more frequently than their urban counterparts due to shortages of rural surgical specialists. Among ophthalmologists, there is a larger workforce density in metropolitan and nonmetropolitan counties compared with rural counties. Previous research shows that as the proportion of a county’s urban residents increases, the density of ophthalmologists increases, highlighting the scarcity of rural ophthalmologists.”
In their work, the researchers found only 5.6% of surgeons practiced in rural areas, compared to 17.4% of patients residing rurally. Rural representation varied by subspecialty:
- Cornea: 4.3%
- Glaucoma: 7.5%
- Oculoplastic: 6.9%
- Retina: 4.9%
- Strabismus: 4.2%
Between 2012 and 2022, the percentage of rural surgeons declined across all subspecialties:
- Cornea: -1.3%
- Glaucoma: -3.3%
- Oculoplastic: -2.1%
- Retina: -0.4%
- Strabismus: -1.0%
The South had the highest concentration of subspecialist surgeons, while the Midwest and Northeast exhibited the lowest densities for cornea, glaucoma, and retina subspecialties. Surgeons practicing in the Midwest were more likely to serve rural populations, while those in the Northeast and West were less likely. Female surgeons were significantly less likely to practice rurally, as were recent graduates (0 to 10 years since medical school) compared to surgeons with 11 to 20 years of experience. Glaucoma surgeons were more likely to practice in rural areas compared to other subspecialties.
“Limited access to ophthalmic care generates negative outcomes among rural or patients in underserved communities,” the researchers wrote, "including increased prevalence of visual impairment, diabetic retinopathy, and macular degeneration. As such, it is crucial that there is a rural ophthalmic subspecialist workforce available to meet rural patients’ ophthalmic needs.”
They concluded, “understanding the demographics of subspecialist surgeons who choose to practice in rural areas may help to develop incentives for rural practice…including financial compensation, debt forgiveness, research stipends, predefined service obligations, and enhanced work-life balance."
A full list of author disclosures can be found in the published research