The Rural Shortage of Ophthalmic Subspecialists

Although 20% of the US population resides in rural areas, less than 10% of US physicians practice in rural areas. This disparity is even more stark among specialists compared with primary care physicians. In 2022, there were nearly 7 times as many cardiologists and 8 times as many dermatologists in urban areas as in rural areas. A shortage of specialists may result in increased burden on generalist health care professionals who may need to manage conditions typically treated by specialists. Ophthalmology is no exception: 61% of counties lack an ophthalmologist and 24% have neither an ophthalmologist nor an optometrist. As a result, 11.7% of Americans live in counties without any ophthalmologists. Counties with low availability of ophthalmologists were also those with lower population densities and higher proportions of rural residents. These disparities are particularly concerning, as rural residents are more likely than urban residents to be older than of 65 years, below the federal poverty level, and uninsured. Many leading causes of blindness, such as glaucoma and macular degeneration, are age related, while others, like diabetic retinopathy, are linked to poorly controlled systemic disease. Moreover, these chronic conditions require ongoing treatment, often involving procedures or surgeries performed by ophthalmic subspecialists. Thus, shortages in ophthalmic subspecialty care, as well as in comprehensive care, may exacerbate existing health disparities and restrict access to critical ophthalmic services.

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