The young ophthalmologist Assuming the challenge. Stefan Seregard

Transcription

1 The young ophthalmologist Assuming the challenge Stefan Seregard

2 I have no financial disclosure (meaning I do not make money from this, unfortunately..)

3 The world has 7.2 billion people and there are 200,000+ ophthalmologists worldwide

4 Resnikoff S et al Br J Ophthalmol 2012;96:

5 Resnikoff S et al Br J Ophthalmol 2012;96:

6 The countries in Europe have 733 million people and there are 60,000 ophthalmologists i.e. 11% of the world s population has 30% of the ophthalmologists

7 The size of national ophthalmological socities varies ,

8 Ophthalmologists per million capita (mean = 83) Eurotimes 2013:18:33

9 A large number of ophthalmologists poses unique challenges Scope of practise defined by relative number of ophthalmologists Few ophthalmologists largely surgical and some highly subspec medical Many ophthalmologists surgical and medical (and refractions)

10 Being at a crossroads can be confusing

11 The ophthalmologist is at a crossroads of subspecialities retina glaucoma paediatric refractive comprehensive oculoplastics

12 European subspecialty societies in ophthalmology (not complete) ESCRS Euretina EVRS EGS EPOS EuCornea ECLS EEBA EASDec EUGOGO EMOS EUNOS SOIE ESA OOG EOPS members 40 members

13 SUBSPECIALITIES

14 Endangered subspecialties (at least in the United States ) Neuro-ophthalmology Uveitis Paediatric ophthalmology Ophthalmic pathology Common denominator: in the US these subspecialists earn less money

15 The American way to subspecialise $ $ $ $ $$$ $$$

16 US ophthalmologists earnings US ophthalmologist earnings average $ 291,000 (10/25) Up 5% compared with 2013 (3/25) Low end: Neuro-ophthalmologists $ 100, ,000 High end: Retina specialists injecting $ 500,000 Medscape s Physician Compensation Report 2014 (

17 A small number of ophthalmologists poses unique challenges Scope of practise defined by relative number of ophthalmologists Few ophthalmologists largely surgical and some highly subspec medical Many ophthalmologists surgical and medical (and refractions)

18 Medical Ophthalmologists (ophthalmic physicians) A unique UK speciality (since 2007) based on 2 years of training in internal medicine and then 4 years of training in medical ophthalmology: uveitis vasculitis diabetic retinopathy thyroid eye disease age-related macular degeneration neuro-ophthalmology A resident in (surgical) ophthalmology may shift to medical ophthalmology after 2 yrs of training.

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21 Nurse practioners Independently or semi-independently practice medicine May perform intravitreal injections in UK, Finland and now Sweden (In parts of Sweden nurses now perform diagnostic ultrasonography and endoscopies. Nurse practioners have rights to prescribe a range of drugs)

22 Optometrists Dispensing opticians Refracting opticians Optometrists (not recognized in many countries) separate training programmes in UK and USA as a 4-year optional add-on to optician training (Sweden) Key issue is independent reimbursement

23 The traditional optician/optometrist

24 Optometry and scope of practise? The new primary health care provider in ophthalmology? Replacing the comprehensive ophthalmologists

25 Do we all need to subspecialise in the future? cornea uveitis neuroophthalmology glucoma retina oculoplastics comprehensive optometry

26 Is a divide emerging? Comprehensive ophthalmology Subspecialised ophthalmology

27 Internists practising only a subspeciality of internal medicine Country Proportion Poland 0% Rumania 0% Czech Republic 5% Portugal 5% Austria 10% Belgium 10% France 10% Italy 10% Latvia 10% Slovenia 10% Slovakia 15% Ireland 20% Spain 20% Country Proportion Switzerland 20% United Kingdom 20% Denmark 25% Germany 30% Israel 30% Netherlands 30% Turkey 30% Greece 40% Finland 60% Lithuania 65% Iceland 80% Norway 85% Sweden 85% Cranson M et al Eur J Int Med 2013;23:

28 Ophthalmologists need to look straight and have a clear vision

29 Get everyone on board

30 Realizing that different people have different agendas

31 Identify where the problems are

32 We need both comprenhensive and subspecialist ophthalmologists

33 But you need to recognize that you are one of a team of ophthalmologists

34 Bring cohesion to your national ophthalmologists

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