Micieli Jonathan A, Micieli Andrew, Schlenker Matthew B, Kertes Peter J
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto.
Faculty of Medicine, University of Ottawa, Ottawa, Ont.
Can J Ophthalmol. 2014 Aug;49(4):312-9. doi: 10.1016/j.jcjo.2014.02.010. Epub 2014 Jul 19.
The past decade has seen significant paradigm shifts in the management of many retinal diseases. The goal of this study is to assess the effect these advances have had on the number of retinal specialists, and the differences in output between medical and surgical specialists at the population level.
Population-based analysis of surgical and medical retina therapeutic and diagnostic procedures among all ophthalmologists in Ontario, Canada, from April 1999 to March 2012.
This study included all ophthalmologists with an Ontario license and receiving remuneration from the Ontario Health Insurance Plan (OHIP). Ophthalmologists were categorized as a surgical or medical retina specialist based on the type and volume of retina-specific procedures performed each year.
The IntelliHealth database operated by the Ministry of Health and Long Term Care was used to obtain anonymized physician services, which has excellent accuracy for procedure performance.
The number of retina specialists grew from 9.7% to 14.4% of the ophthalmology workforce. The proportion of late-career retina specialists (>25 years since graduation) doubled but had no influence on procedure output. Almost all retina specialists (90%) practice in the region they graduated medical school, and most (65%) practice in counties with a population greater than 400,000 people. Over the study period, the mean number of photocoagulation and fluorescein angiography performed was significantly higher among surgical retina specialists. Scleral buckling declined by 55% over the study period, whereas the number of pars plana vitrectomies grew by 49%.
The retina subspecialty is a growing area of ophthalmology and is mainly located in urban centres. There has been a dramatic shift in the types of procedures performed to treat medical and surgical diseases over the past decade. To our knowledge, this is the first study to quantify differences in diagnostic and procedure performance between the medical and surgical retina subspecialties.
在过去十年中，许多视网膜疾病的管理发生了重大范式转变。本研究的目的是评估这些进展对视网膜专科医生数量的影响，以及在人群层面内科和外科专科医生的产出差异。
对1999年4月至2012年3月期间加拿大安大略省所有眼科医生进行的基于人群的视网膜外科和内科治疗及诊断程序分析。
本研究纳入了所有持有安大略省执照并从安大略省健康保险计划（OHIP）获得报酬的眼科医生。根据每年进行的视网膜特定程序的类型和数量，眼科医生被分类为视网膜外科或内科专科医生。
使用由卫生和长期护理部运营的IntelliHealth数据库获取匿名医生服务，该数据库对程序执行情况具有极高的准确性。
视网膜专科医生数量从眼科劳动力的9.7%增长到14.4%。职业生涯后期的视网膜专科医生（毕业超过25年）的比例翻了一番，但对程序产出没有影响。几乎所有视网膜专科医生（90%）都在他们医学院毕业的地区执业，大多数（65%）在人口超过40万的县执业。在研究期间，视网膜外科专科医生进行的光凝和荧光素血管造影的平均数量显著更高。在研究期间，巩膜扣带术下降了55%，而玻璃体切除术的数量增长了49%。
视网膜亚专科是眼科中一个不断发展的领域，主要位于城市中心。在过去十年中，治疗内科和外科疾病所采用的程序类型发生了巨大转变。据我们所知，这是第一项量化内科和外科视网膜亚专科在诊断和程序执行方面差异的研究。
