Footnotes:
1: The release of the Abt. report did not receive much publicity and most optometrists remain unaware of its findings. Those citing its findings today are told it is outdated because it did not predict passage of the Affordable Healthcare Act, the impact of the increasing elderly population and enrollment increases.
However, the Abt. model was specifically designed to be easily updateable and could have been by entering future graduation rates in its supply model and estimating the impact of the Affordable Care Act on demand. Instead, a new study by the Lewin Group was commissioned by the AOA utilizing external, corporate funding.
To date, the impact of the ACA has increased the number of potential 3rd party patients by around 8 million which is 2.5% of current U. S. population. If all 8 million seek optometry care every two years, this could produce 4 million visits a year or about 90 additional visits per optometrist per year. Since the average number of visits to an optometrist is about 3,600 per year, this increase in visits would average to only a 2.5% increase. [This is an overestimate since elderly patients tend (70%) to select ophthalmologists compared to younger patients, and not all eligible under the ACA will seek, or need eye care.]
Such a small increase in demand from the ACA can not make a dent in future supply surpluses and high optometry densities.
2: From 1975 to1990, applications to dental schools declined from 2.5 to 1.26 per seat attributable to articles in the media that fluoridation of water and its inclusion in toothpaste would reduce the need for dentists. During that time 7 dental schools closed.
Although it was commonly believed these closings were done to regulate the number of dentists, Dr. Richard Smith, dean of one school that closed stated “The closure of dental schools…had absolutely nothing to do with recommendations from a national dental association.”
Dr. Eric Solomon, who at that time served as assistant director for application services and resource studies at the American Dental Association, said “I was the one who had to tell everybody …the application pool was falling off the table.”
Dr. Solomon believes “only a drop-off in student demand compels a decision as momentous as closing a school.” [or reducing enrollment]… “It is my thesis that until the applicant pool is affected, nothing will change. The educational associations, the professional associations and the institutions themselves do not have a vested interest in reducing enrollment.”
Dr. Smith, now dean of his university’s Graduate School of Arts and Sciences, comments on the educational boom-bust cycle this way. “We do that with everything, with building malls and building condos. When it looks like a good thing, we build too many and then everyone suffers. [Emphasis added]
3. Current D may be higher than the 12.8 or 13.4 values based upon the AOA figure of 40,000 active optometrists in 2012 projected to 2014. Surprisingly, it is difficult to find sources for the total number of US licensed optometrists. The author found three, higher, estimates of total current supply. The highest was furnished by ARBO, the Association of Regulatory Boards of Optometry (personal e-mail communication). Its OE Tracker system is used to record, track and report to state licensing boards the continuing education hours taken by licensed optometrists required for re-licensing,
When asked about total numbers of licensed US optometrists, the author was told, “We currently have 46,435 ODs in OE Tracker who have an active license in the US.”
When asked “Are these unique ODs?” the reply was “Yes”.
Asked if there might be duplications due to multiple state licenses the response was, “No. OE Tracker numbers are unique to the OD regardless of how many states he or she is licensed in. It is the number of ODs who have an OE Tracker number and a license by a US optometry board.”
Other sources located by the Author gave between 42,000 and 43,000 as the total number of licensed U.S. optometrists at this time compared to the AOA value of 40,000 for 2012.
The 2012 D of 12.8 in this study is based upon a 2013 AOA publication stating there were 40,000 licensed ODs in 2012 but D may now be as high as 14.8 at this time if the ARBO data is correct.
4. Total number of graduating optometrists includes those from the school in Puerto Rico.
5. A 3rd , new school, is under consideration in Wisconsin.
Appendix:
How to Use Tables 1 and 2
There are 10 columns with the following headings and meanings:
Year Data for this year is shown to the right
Pop. Populations in millions rounded to nearest million
Leaving Projected number leaving practice due to death, disability or retirement.
# Grads Projected total number of new graduates
Net Net increase in numbers of ODs, [#Grads – #Leaving]
O.D.s Total number of active, licensed US optometrists.
D Density (number of ODs per 100,000 population)
#for 11.5 Number of ODs required for a density D of 11.5
#for 12.8 Number of ODs required for a density D of 12.8
#for 14.0 Number of ODs required for a density D of 14.0
To determine the surplus in a year in which a Density of 11.5, 12.8, or 14 is required for supply to equal demand, subtract the number listed required for that density [last 3 columns] from the number of optometrists projected for that year [column 6]. The result is the number of optometrists in surplus to the number required for each density level.
For example, suppose one predicts that in 2040, due to “Obama Care, or other legislative changes, a density of 12.8 ODs per 100,000 will be required to meet demand and that graduation rates since 2018 have been 1,900. The # required for a density off 12.8 in 2040 is 48,640 in column 9 and column 6 indicates this graduation rate will result in a total of 58,940 optometrists in that year.
The surplus in 2040 is therefore 62,440 – 48,640 = 13,800.
Tables 3 and 4 were generated in this manner from data in Tables 1 and 2.
If the reader studies these tables and computes projected surpluses a few times, or studies Tables 3 and 4, it becomes clear these surpluses are sufficiently large that any reasonable future increase in demand would still leave surplus numbers of optometrists. This is seen in Figure 2 which projects future densities. To not have surplus numbers of optometrists, the demand for optometry care would have to increase in step with the increase in density resulting from high enrollments. This is highly unlikely.
How to use Table 3 and 4. For the convenience of the reader, future surpluses are calculated from Tables 1 and 2 as explained above and tabulated in Tables 3 and 4. Simple linear proportional extrapolations can be performed to find surpluses for values of D not listed.
Basic Data Sets
Table 1: Graduation Rate = 1,900 by 2020
| Year | Pop. | Leaving | # Grads | Net | O.D.s | D | # for 11.5 | # for 12.8 | # for 14 |
| 2010 | 309 | 697 | 1,200 | 503 | 38,758 | 12.5 | 35,535 | 38,625 | 43,260 |
| 2015 | 321 | 899 | 1,700 | 801 | 42,760 | 13.3 | 36,915 | 41,088 | 44,940 |
| 2020 | 333 | 1,032 | 1,900 | 868 | 47,100 | 14.1 | 38,295 | 42,624 | 46,620 |
| 2025 | 346 | 1,070 | 1,900 | 830 | 51,250 | 14.8 | 39,790 | 44,288 | 48,440 |
| 2030 | 358 | 1,077 | 1,900 | 823 | 55,365 | 15.5 | 41,170 | 45,824 | 50,120 |
| 2035 | 369 | 1,185 | 1,900 | 715 | 58,940 | 15.9 | 42,435 | 47,232 | 51,660 |
| 2040 | 380 | 1,200 | 1,900 | 700 | 62,440 | 16.4 | 43,700 | 48,640 | 53,200 |
| 2045 | 389 | 1,200 | 1,900 | 700 | 65,940 | 17.0 | 44,735 | 49,772 | 54,460 |
| 2050 | 399 | 1,200 | 1,900 | 700 | 69,440 | 17.4 | 45,885 | 51,072 | 55,860 |
| 2055 | 409 | 1,200 | 1,900 | 500 | 71,940 | 17.6 | 47,035 | 52,352 | 57,260 |
| 2060 | 420 | 1,200 | 1,900 | 0 | 73,190 | 17.4 | 48,300 | 53,760 | 58,800 |
Table 2: Graduation Rate = 1,700 by 2020
| Year | Pop. | Leaving | # Grads | Net | O.D.s | D | # for 11.5 | # for 12.8 | # for 14 |
| 2010 | 309 | 697 | 1,200 | 503 | 38,758 | 12.5 | 35,535 | 38,625 | 43,260 |
| 2015 | 321 | 899 | 1,700 | 801 | 42,760 | 13.3 | 36,915 | 41,088 | 43,260 |
| 2020 | 333 | 1,032 | 1,700 | 668 | 46,100 | 13.8 | 38,295 | 42,624 | 46,620 |
| 2025 | 346 | 1,070 | 1,700 | 630 | 49,250 | 14.2 | 39,790 | 44,288 | 48,440 |
| 2030 | 358 | 1,077 | 1,700 | 623 | 52,365 | 14.6 | 41,170 | 45,824 | 50,120 |
| 2035 | 369 | 1,185 | 1,700 | 515 | 54,940 | 14.9 | 42,435 | 47,232 | 51,660 |
| 2040 | 380 | 1,200 | 1,700 | 500 | 57,440 | 15.1 | 43,700 | 48,640 | 53,200 |
| 2045 | 389 | 1.200 | 1,700 | 500 | 59,940 | 15.4 | 44,735 | 49,772 | 54,460 |
| 2050 | 399 | 1,200 | 1,700 | 500 | 62,440 | 15.7 | 45,885 | 51,072 | 55,860 |
| 2055 | 409 | 1,200 | 1,700 | 700 | 62,740 | 15.3 | 47,035 | 52,352 | 57,260 |
| 2060 | 420 | 1,200 | 1,700 | 0 | 62,890 | 15.0 | 48,300 | 53,760 | 58,800 |
(Population numbers from U.S. Census Bureau)
Surplus Numbers of Optometrists
Table 3: Surplus Numbers with a Graduation Rate = 1,900 by 2020*
| __ | If D=11.5 is needed for supply = demand | If D=12.8 is needed for supply = demand | If D=14 is needed for supply-demand |
| Year | Excess numbers | Excess numbers | Excess numbers |
| 2010 | 3,223 | 133 | -4,502 |
| 2015 | 5,845 | 1,672 | -2,180 |
| 2020 | 8,805 | 4,476 | 480 |
| 2025 | 11,460 | 6,962 | 2,810 |
| 2030 | 14,195 | 9,541 | 5,245 |
| 2035 | 16,505 | 11,708 | 7,280 |
| 2040 | 18,740 | 13,800 | 9,240 |
| 2045 | 21,205 | 16,168 | 11,480 |
| 2050 | 23,555 | 18,368 | 13,580 |
| 2055 | 24,905 | 19,588 | 14,680 |
| 2060 | 24,890 | 19,430 | 14,390 |
* Estimated based on 2 additional school’s graduates
Table 4: Surplus Numbers with a Graduation Rate = 1,700 by 2020
| ___ | If D = 11.5 is needed for supply = demand | If D = 12.8 is needed for supply = demand | If D = 14 is needed for supply = demand |
| Year | Excess numbers | Excess numbers | Excess numbers |
| 2010 | 3,223 | 133 | -4,502 |
| 2015 | 5,845 | 1,672 | -2,180 |
| 2020 | 7,805 | 3,476 | -520 |
| 2025 | 9,460 | 4,962 | 810 |
| 2030 | 11,195 | 6,541 | 2,245 |
| 2035 | 12,505 | 7,708 | 3,280 |
| 2040 | 13,740 | 8,800 | 4,240 |
| 2045 | 15,205 | 10,168 | 5,480 |
| 2050 | 16,555 | 11,368 | 6,580 |
| 2055 | 15,705 | 10,388 | 5,480 |
| 2060 | 14,590 | 9,130 | 4,090 |
How Optometry Enrollments Compare
| Specialty | 1985 | 1990 | 1995 | 2000 | 2005 | 2010 | Change |
| M.D. | 15,938 | 15,043 | 15,341 | 15,403 | 15,461 | 16,356 | +2.6% |
| Dental | 5,046 | 3,699 | 3,697 | 4,391 | 4,389 | 4,918 | -2.5% |
| Podiatry | 612 | 589 | 650 | 528 | 347 | 491 | -20% |
| D.C. | 3,395 | 2,647 | 3,379 | 3,769 | 2,564 | 2,601 | -23% |
| Law | 35,844 | 37945 | 39,828 | 37,904 | 43,423 | 44,345 | +24% |
| O.D. | 1,029 | 1,115 | 1.231 | 1,289 | 1,198 | 1,335 | +30% |
| D.O. | 1,547 | 1,459 | 1,895 | 2,450 | 2,718 | 3,890 | +150% |
Source: Digest of Educational Statistics, National Center for Ed. Statistics, US Dept. of Education
http://nces.ed.gov
1. More recent values not available.
2. The rise in optometry graduates following the 1997 Abt. Report is reflected beginning in 2010.
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