The Modern Optometry Era
“Modern optometry” began after WWII when enrollments from 1945-1954 briefly quadrupled as returning veterans utilized the GI Bill to gain undergraduate degrees and postgraduate training in the health professions.
As Figure 2a illustrates, optometry densities had been declining since 1930 from the effects of states legislating optometry licensing laws and boards of registration.
Those boards “grandfathered” many older optometrists who often had substandard training and were retiring in increasing numbers after1930. Without the impact of the GI Bill, D would have declined to about 10 around 1950. But the GI Bill, created an all time record D = 14 which then declined to about 10 by 1970 and would have stayed at this level except new schools began to be established about this time and enrollments increased.
All “grandfathered” optometrists had retired by 1965 when D hovered at 10 with 1965 graduation rates of about 500.
As the following data, and Figures 2 and 2a show, the modern optometry era began about 1970 with a D of 10 which has been rapidly increasing ever since due to additional schools being established. The details follow:
1. 1967 D = 10. The American J. of Public Health published “Vision Manpower in the United States” which graphed D declining from 14 at the record peak of 14 in 1952 to 10 by 1967.
2: 1968 D=9.3 The U.S. Dept. of Health, Education and Welfare published, in 1968, “Optometric Manpower: Characteristics of Optometric Practice” which found D at 9.3.
3: 1973 D = 9.4 The1973 landmark “National Study of Optometric Education” conducted by the National Commission of Accrediting” stated on page 23, in the chapter “Manpower in Optometry”, the average national Density was 9.4, with about 1,000 entering the 12 U.S. schools of optometry and about 21,000 registered optometrists.
4: 1974 D = 10 in a paper published in 1974 by the author showing from 1930 to 1974 D had declined from 13.9 down to 10 with a local peak of 14 in 1952 from GI Bill optometry students.
5: In 1992-94 the “Georgetown Summit: A Critical Assessment of Optometric Education” issued Action Item S1 calling for the immediate development and publishing by the AOA and IAB of accurate assessments of optometric manpower every 5 years. This may have triggered AOA funding the 2000 Abt. manpower report.
6: 1997 D = 11.5 In March, the Project Hope Center for Health Affairs issued the “First National Census of Optometrists” which showed D had increased to 11.5. This census data was used in the 2000 Abt. Associates manpower study.
7: 1998 D = 11 A report by the AOA about this time stated D was 11.
8: 2000 D = 11.5 The 2000 Abt. Associates “Workforce Study of Optometrists” found the average national D to be 11.5 [page 109] in 1997 utilizing the census data of Project Hope.
9. 2012 D = 12.8 In its 2013 State of the Profession the AOA reported 40,000 optometrists in practice in 2012 or a D of 12.8 for a 2012 population of 315,091,000.
10. 2012 D = 12.6 In 1997 Abt. projected 39,685 optometrists for 2012 or a D of 12.6*
*This is D = 12.7 if graduation rates from 1997 to 2012 are inserted in Abt’s model.
U S Population Growth:
As of June 2014, total U S resident population was 318,150,000 [US Census Bureau].
Over the 20th century, U S population grew at an average annual rate of 1.3%.
But, the growth rate for past 20 years averaged 0.98% and for the past 10 years averaged 0.84%. Still lower rates in the future are predicted by the US Census Bureau.
Future population projections used in this study are those of the US Census Bureau.
Numbers of US Optometrists:
The National Census of US Optometrists in 1997 counted 30,510 with active licenses. This number was used in the Abt. Report as the base number for the 1997.
Abt projected that with a graduation rate of 1,127 per year, numbers of optometrists would increase from 30,510 in 1997 to 42,356 by 2030. Abt. concluded this would produce future surpluses of optometrists that peaked at just over 4,000 (10 % surplus) centered about 2015 and would decline to about 3% in 2030 with 42,356 in practice.
Graduation Rates Determine Steady State Numbers of Future Optometrists
The future steady state number of optometrists T, is determined by the following equation in which G is number of graduates/year, A the annual attrition percentage due to death, disability or retirement* and T the total number of future optometrists. [Figures 3,4]
T x A = G
To achieve steady state, losses/year must = gains/per year, or
(Total number in practice) x (percent leaving practice) = (graduates per year).
In 2016 the graduation rate will reach 1,700. [In 2013 it was 1,567 and 1,127 in 1997]
If graduation rates remain at a certain level, the net number T will grow each year until T becomes large enough that the attrition rate of 2.5% times T balances G. This future total will be:
1: If graduation rate = 1,700/year.
T(0.025) = 1,760, or T= 68,000 optometrists.
2: By 2018, with 2 additional schools, the graduation rate may reach 1,900.
T(0.025) = 1,900, or T = 76,000 optometrists.
3: In base year 1997 with supply equal to demand, the number of graduates was about 1,127 which would have produced a future T = 45,800 vs. the above numbers.
Since it takes approximately 35 years to reach steady state levels, surpluses grow each year until reaching the eventual peak D which then slowly erodes, if graduation rates continue unchanged, as population grows at about 0.8% per year thereafter.
Here are a range of graduation rates and the eventual T each produces.
Grads per year Future T
1,000 40,000
1,100 44,000 and the average female for 38 years. If half of future
1,200 48,000 practitioners are female, the average career length is 40
1,300 52,000 years which produces an average annual attrition rate of
1,400 56,000 2.5% due to death, disability or retirement.
1,500 60,000
1,600 64,000
1,700 68,000
1,800 72,000
1,900 76,000
2,000 80,000
Data show the average male OD practices for 42 years
and the average female for 38 years. If half of future
practitioners are female, the average career length is 40
years which produces an average annual attrition rate of
.5% due to death, disability or retirement.
Will Population Growth Absorb Surplus Optometrists?
It will take about 23 years after D reaches its future peak for population growth to reduce D to its value in base year 1997 since future annual population growth rates projected by the US Census Bureau will require 23 years to grow the population sufficiently to reduce peak D to 11.5 [Assuming no additional schools open.]
For example, by the time 1,900 graduates/year produces a stable 76,000 optometrists [a 150% increase in T from the1997] the population will have increased by only 35%. It will then take about 23 years of additional population growth for D to decline to its 1997 value of 11.5.
Thus, with 1,700 – 1,900 graduates/year the density of optometrists will continue to rise each year for about 35 years until peaking and then slowly declining.
These findings indicate great care must be taken when enrollments are increased and the long range implications of these increases must be critically considered. This is difficult since it is in the short-term interests of schools to maximize enrollments and revenues. In addition, once a higher enrollment exists it is often difficult to reduce that enrollment level.
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