Patients Struggle to Access Health Care in Rural Areas

Across the United States, many patients find accessing healthcare challenging, especially in rural regions. Long distances often need to be traveled to reach specialists. Eye care is notably affected, with the demand for ophthalmologists exceeding their availability.

A trained workforce of optometrists exists but remains underutilized due to laws restricting their procedures. In over twelve states, optometrists can perform YAG laser capsulotomy, a simple in-office procedure for ‘secondary cataracts’ that occur post-cataract surgery. Over 500,000 seniors undergo this procedure annually, with an excellent safety record. Yet, most states only permit ophthalmologists to execute them.

Restricting optometrists has significant consequences. In 2020, there were thrice the number of optometrists as ophthalmologists in the U.S. While ophthalmologists cluster in urban areas, over 99% of counties have an optometrist. Patients requiring YAG procedures encounter lengthy waits and high travel expenses to consult an ophthalmologist.

Safety is paramount in healthcare. Concerns exist about letting unqualified individuals perform risky procedures; however, optometrists pose little risk. Their doctoral training incorporates YAG surgery, and additional certification is required in some cases. A review in the U.S. of nearly 150,000 procedures showed negative outcomes were only 0.001%, reflecting high safety levels. In countries like the U.K. and New Zealand, optometrists have safely performed these procedures.

A recent Pacific Legal Foundation policy brief reveals that expanding optometrists’ scope to include YAG procedures leads to increased utilization. Medicare patients in states allowing optometrists more latitude for YAG procedures between 2013 and 2023 saw a 19% rise in procedures compared to restrictive states. States expanding scope before 2013 experienced a 42% increase, indicating improved eye care access.

The findings suggest expanded scope-of-practice for optometrists enhances eye care access. Patients facing travel burdens or scheduling delays now receive necessary treatment. Policymakers glean two key insights from this data: the effects of scope expansion grow with time, indicating the healthcare market adapts to regulatory changes. Acting now secures long-term benefits.

Additionally, larger increases in YAG procedures are noted in non-metropolitan areas compared to urban regions. This implies geographically isolated individuals facing severe access issues benefit most from allowing optometrists to operate fully.

Such reform isn’t new. Over two decades, many states expanded scope-of-practice laws for non-physician providers. Evidence supports positive results, with improved access, lowered costs, and enhanced system flexibility. Optometry should follow suit.

Despite this, resistance is probable from organized ophthalmology groups. Professional territorial disputes are historically persistent. The focus should remain on patient benefits rather than control over procedures. With an aging U.S. population, increasing eye care demands will exacerbate ophthalmologist scarcity. Reducing care delays, particularly in underserved regions, requires leveraging available resources.

Enabling optometrists to perform more tasks offers a straightforward solution to ensure essential services reach patients.