How many schools are too many?

Two of the most discussed matters in the optometric profession today are the number of new schools opening and whether the increasing number of graduating ODs will add to the perceived oversupply of ODs.

There are currently 21 optometry schools, public and private, with another proposed school in Virginia tentatively scheduled to enroll its first class in 2014. Four new schools have enrolled students in the past few years; some of those schools are now graduating their first classes.

According to the Association of Schools and Colleges of Optometry (ASCO), in 2012 the 21 current schools had 2,545 individuals apply for the 1,797 first-year spots available. For the 2011-2012 academic year, there were a total of 6,289 students enrolled in the 20 schools operating then. That represented a 14.6% increase in total enrollment since 2006.¹ With the opening of the two new schools, that number will increase by approximately 112 students per academic year for a total of approximately 6,737 optometry students once the two newest schools enroll all four class years. In 2011, there were 1,308 graduates.¹ When all 22 schools start graduating students, that number could easily exceed 1,600 per year, a 22% increase in graduates per year compared with 2011. In 2008, there were 34,800 practicing ODs, and, at the present rate of growth, the projection is that there will be 43,200 practicing ODs by 2018, a 24% increase in 10 years.²

Several concerns regarding the schools must be scrutinized:

• Increasing the applicant pool so schools are not pressured to accept marginally qualified students in order to fill their classes.

• The level of clinical experience schools will be able to provide to students.

• Whether the schools will be able to obtain the necessary skilled teaching staffs.

• The amount of debt incurred by students and their ability, after graduation, to secure a professional position that will provide the income necessary to meet cost-of-living and debt load expenses.

If schools cannot meet the didactic and clinical education requirements for their students, or if schools accept marginally qualified students, then we may see the National Board of Examiners in Optometry (NBEO) pass rates begin to decline or graduates just barely being able to pass board exams. What effect will that have on the quality of graduates at a time when ODs are taking on a greater role in the medical eye care of their patients?

According to the American Optometric Association Research and Information Center, the average number of patients treated per week per OD in 2012 was 60, or 1.52 patients per hour.² Compare that with ophthalmologists who average seeing about 125 patients per week, according to Medscape.³ When you also consider that most ODs now accept reduced examination fees for 61% of their patients (2) due to the prevalence of vision care plans, it has become more difficult to increase, let alone maintain, annual income levels.

With advanced technology and trained paraoptometrics at work in many OD offices, why is the average number of patients seen per hour so low? Are ODs  that inefficient, or is the ratio of total ODs  to the pool of patients seeking care so high that their offices are underutilized? The assumption is that most ODs would easily be able to accommodate more patients per week than they currently see. If that is the case, then the significant increase in total ODs due to the opening of more schools every year would seem to indicate that there will be such a large oversupply of ODs in a few years that it could be detrimental to the overall health of the profession. The ability of new graduates to find good positions would become more difficult than it currently is.

Some people believe that the aging population, along with the effects of the Affordable Care ACT (ACA), will significantly increase the number of patients seeking eye care services. However, considering that baby boomers-one of the largest groups that make up the older population-are already using eyecare services due to normal age-related eye conditions, that eliminates a significant group of new patients.

An argument could be made that the approximately 30 million people who will have coverage through state health insurance exchanges may already take advantage of the relatively inexpensive basic eye care available through various sources. Will that wave of new eyecare consumers materialize as some have predicted, or are these individuals already receiving care?

Now for the main question: Are there too many schools graduating too many optometrists, which could cause harm to the profession?

The answer to that seems to be yes, for several reasons.

• Many new graduates in several regions of the U.S. are unable to find full-time work in one office, so they must work in 2 or 3 different offices to make a reasonable income.

• As ODs are forced to increase the efficiency and profitability of their practices by seeing more patients per hour in the face of increasing practice expenses and continued erosion of net income per patient, that will further increase the surplus of ODs The adage, “Work harder to make less” will definitely come into play to a greater extent than it does today.

• As oversupply multiplies, more ODs will be forced to work in some sort of commercially affiliated position, which could eventually lead to the profession becoming more like the retail pharmacy industry, where few independent practices exist. Unfortunately, in many of these commercially affiliated practices, the OD is discouraged from practicing full-scope care in favor of the production of eyeglasses and contact lens prescriptions. Patient care may suffer as a result.

Is there a solution to the problem of too many schools producing too many optometrists? Apparently, at this time there is not.

The American Optometric Association (AOA) has not taken an official position on this issue and, apparently, neither has the Accreditation Council on Optometric Education (ACOE), which is responsible for the accrediting schools. Should accrediting standards, especially as they apply to student clinical experiences, be enhanced to make it more difficult to start a new school?

The only solution? If some of the schools are unable to find qualified applicants who can finish the curriculum and pass the NBEO exams to become licensed. The applicant pool may shrink dramatically if education becomes cost prohibitive, without the ability for graduates to earn an equitable income. How long will it be before we see optometry schools sued by their graduates for misleading them about their job prospects after graduation, as we’ve seen happen with several law schools?

Only time will tell how this surplus of schools and optometrists will affect the profession. Hopefully, some entity with the ability to effectively deal with the problem, presumably the AOA, which has a great deal of input to both the ACOE and ASCO, will step in before it is too late. At this time, it seems that the AOA is either unwilling or unable to step up. It will be interesting to see how the results of the AOA’s manpower study are interpreted.ODT

References

1. Association of Schools and Colleges of Optometry.Profile of the 2012 Optometry Entering Class. www.opted.org. Accessed May 15, 2013

2. American Optometric Association Research and Information Center. Practicing Optometrists and Their Patients. www.aoa.org/x18446.xml. Accessed May 15, 2013.

3. Ophthalmologist Compensation Report 2013. www.medscape.com/features/slideshow/compensation/2013/ophthalmologists. Accessed May 15, 2013.

Author Info Thomas Cheezum, OD, has been in private practice for 35 years in Chesapeake, VA. Dr. Cheezum is a past member of the American Optometric Association (AOA), the Virginia Optometric Association, and the Virginia Board of Optometry. He is currently treasurer of the American Optometric Society.