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Nearly half of all U.S. states may be at risk of low access to pediatric ophthalmologists in the next 5 years due to retirement, a forecasting model suggested.

In a model where pediatric ophthalmologists started at age 35 and retired at age 60 (25 years in practice), 23 states would likely face a risk of providers, reported Paul Phillips, MD, of the University of Arkansas in Little Rock, and colleagues.

These included 11 states in the South, five in the Midwest, four in the West, and three in the Northeast, they noted in a research letter published in . Southern states included a cluster formed by Arkansas, Louisiana, Mississippi, Georgia, and Kentucky that were at risk.

However, if the average pediatric ophthalmologist worked more than 30 years in practice (starting at age 30 and retiring at age 60), only two states would likely run the risk of losing access to pediatric ophthalmology care within the next 5 years: Wyoming and Virginia.

Pediatric ophthalmologists in Wyoming have been in practice for more than 35 years on average -- the longest in the nation -- followed closely by Virginia, where providers have spent more than 30 years in practice. Those two states in particular are predicted to have the lowest future numbers of pediatric ophthalmologists due to expected retirement rates.

No state had providers with an average number of years in practice above 40.

Across the country, the median length of time pediatric ophthalmologists spent in practice was 24 years, the researchers reported. On a regional level, doctors in the Northeast had the highest average years in practice at 25.56 years, followed by those in the South with 24.95 years, the West with 23.9 years, and the Midwest with 23.59 years.

"[T]he pediatric ophthalmology field is facing substantial workforce challenges," Phillips' group observed. Because the study only looked at retirement rates, it "does not account for potential decrease of new pediatric ophthalmologists coming into the field, which could exacerbate projected shortages," they said.

Phillips and co-authors noted that several recent studies have shown access to pediatric ophthalmologist care varies heavily depending on location, referencing a which found that disparities in access to pediatric ophthalmological care were associated with socioeconomic status. In addition, this sub-specialty has seen markedly from resident physicians and heightened retirement rates since the COVID-19 pandemic began, they noted.

Echoing this, Robert Wiggins Jr., MD, MHA, a pediatric ophthalmologist and spokesperson for the American Academy of Ophthalmology (AAO), told 乌鸦传媒 that the quantitative data from the study add to existing anecdotal and survey data about this workforce.

"The aging of the pool of active pediatric ophthalmologists is not only a concern from the standpoint of complete retirement but also because of previous data, which shows older physicians tend to work fewer hours than those early in their careers," Wiggins said. "Previous reports have highlighted the reduced numbers of U.S.-trained ophthalmology residents entering the field of pediatric ophthalmology and reasons for this."

The large-scale, increased rates of retirement by eye-care professionals is "a trend which will compound the problem of fewer residents going into the field," Wiggins said, adding that "economic factors related to inadequate reimbursement related to the high Medicaid population served by this subspecialty serve to affect decisions to both enter and exit from the field, though the problem is multifactorial."

To combat the issue, Phillips and colleagues recommended targeted recruitment efforts and advocacy work aimed at negotiating more favorable remuneration for pediatric ophthalmologists. "These efforts might help increase the access of children to the eye care they need," they wrote.

Wiggins pointed out that the AAO and American Association for Pediatric Ophthalmology and Strabismus (AAPOS) are currently working on advocacy efforts within the field.

For this study, the researchers used databases from the AAPOS, including active, non-retired pediatric ophthalmologists in all states besides Vermont and North Dakota. The researchers computed four forecasting models based on years in practice by subtracting the year of analysis (2022) from the year fellowship was completed.

One limitation of the study was the use of publicly available data, which did not include a complete list of every applicable pediatric ophthalmologist in the country.

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