Ahmed Aishah, Ali Muhammad, Dun Chen, Cai Cindy X, Makary Martin A, Woreta Fasika A
The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
JAMA Ophthalmol. 2025 Feb 1;143(2):117-124. doi: 10.1001/jamaophthalmol.2024.5605.
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.
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).
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.
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.
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.
虽然城市县的眼科医生密度高于农村县，但眼科外科亚专科医生的地理分布尚未阐明。潜在的劳动力差异可能会影响农村外科医生面临的护理负担。
评估眼科亚专科外科医生劳动力的地理分布，并评估与在农村地区执业相关的因素。
设计、设置和参与者：这项基于人群的横断面研究对2012年至2022年进行亚专科手术的医疗保险患者和外科医生进行了研究。2023年，使用当前手术操作术语代码对2012年至2022年期间接受亚专科眼科手术的65岁及以上患者的医疗保险按服务收费索赔进行了分析（n = 1 619 043）。根据当前手术操作术语代码，外科医生被定义为亚专科医生，表明其至少进行了以下亚专科中的1种亚专科手术：角膜、青光眼、眼整形、视网膜或斜视（n = 13 526）。
主要结果是亚专科外科医生的执业人口密度和患者的居住情况（农村或城市）。次要结果是与农村执业相关的特征。
在13 526名眼科外科亚专科医生中，9823名是男性（72.6%），3235名是女性（26.8%），4484名（33.2%）在南方执业。有2540名角膜亚专科医生（18.5%），3676名青光眼亚专科医生（26.8%），1951名眼整形亚专科医生（14.2%），4123名视网膜亚专科医生（30.0%）和1236名斜视亚专科医生（9.0%）。在各个亚专科中，相对于外科医生（5.6%；95%CI，5.3%-5.9%），居住在农村地区的患者比例更高（17.4%；95%CI，16.9%-17.9%），各亚专科的差异在6.2%至14.8%之间。女性外科医生（调整后的优势比[aOR]，0.63；95%CI，0.51-0.79；P <.001）、东北部的外科医生（aOR，0.62；95%CI，0.48-0.78；P <.001）、西部的外科医生（aOR，0.63；95%CI，0.50-0.79；P <.001）以及相对于11至20年前毕业的人（aOR，1.66；95%CI，1.25-2.21；P <.001）、21至30年前毕业的人（aOR，1.83；95%CI，1.38-2.42；P <.001）或31年前或更早毕业的人（aOR，1.43；95%CI，1.08-1.90；P = 0.013），在农村执业的可能性较小。
这项2012年至2022年的横断面研究发现，与农村外科医生相比，农村患者的比例更高。农村外科医生的比例随时间下降，女性外科医生和医学院应届毕业生在农村执业的可能性较小。这表明为农村患者服务的农村亚专科外科医生数量存在差异。
