Geographic Distribution of US Ophthalmic Surgical Subspecialists.

Abstract

Importance: While urban counties maintain higher densities of ophthalmologists than rural counties, the geographic distribution of ophthalmic surgical subspecialists has not yet been elucidated. A potential workforce discrepancy may impact the burden of care faced by rural surgeons.

Objective: To assess the geographic distribution of the ophthalmic subspecialist surgeon workforce and evaluate factors associated with practicing in rural areas.

Design, setting, and participants: This cross-sectional population-based study of Medicare patients and surgeons performing subspecialized procedures took place from 2012 through 2022. Medicare Fee-for-Service claims were analyzed in 2023 for patients 65 years or older who underwent subspecialized ophthalmic procedures between 2012 and 2022 using Current Procedural Terminology codes (n = 1 619 043). Surgeons were defined as a subspecialist based on Current Procedural Terminology codes, indicating performance of at least 1 subspecialty procedure from the following subspecialties: cornea, glaucoma, oculoplastic, retina, or strabismus (n = 13 526).

Main outcomes and measures: The primary outcome was the population density of practice for subspecialist surgeons and residence for patients (rural or urban). The secondary outcomes were the characteristics associated with rural practice.

Results: Among 13 526 ophthalmic surgical subspecialists, 9823 were male (72.6%), 3235 were female (26.8%), and 4484 (33.2%) practiced in the South. There were 2540 cornea subspecialists (18.5%), 3676 glaucoma subspecialists (26.8%), 1951 oculoplastic subspecialists (14.2%), 4123 retina subspecialists (30.0%), and 1236 strabismus subspecialists (9.0%). Across subspecialties, a higher proportion of patients (17.4%; 95% CI, 16.9%-17.9%) resided in rural areas relative to surgeons (5.6%; 95% CI, 5.3%-5.9%) with differences ranging from 6.2% to 14.8% across subspecialities. Female surgeons (adjusted odds ratio [aOR], 0.63; 95% CI, 0.51-0.79; P < .001), surgeons in the Northeast (aOR, 0.62; 95% CI, 0.48-0.78; P < .001), surgeons in the West (aOR, 0.63; 95% CI, 0.50-0.79; P < .001), and recent graduates relative to those who graduated 11 to 20 years ago (aOR, 1.66; 95% CI, 1.25-2.21; P < .001), 21 to 30 years ago (aOR, 1.83; 95% CI, 1.38-2.42; P < .001), or 31 years ago or longer (aOR, 1.43; 95% CI, 1.08-1.90; P = .013), were less likely to practice rurally.

Conclusions and relevance: This cross-sectional study between 2012 and 2022 identified higher proportions of rural patients compared with rural surgeons. Percentages of rural surgeons declined over time, with female surgeons and recent medical school graduates less likely to practice rurally. This suggests a disparity in the number of rural subspecialist surgeons available to serve rural patients.