Survey shows pandemic will limit access to pediatric eye care

Reviewed by Emily Henderson, B.Sc.Sep 1 2020

Pediatric ophthalmologists are a rarity in medicine. There are only about a thousand of them to serve America's 75 million children. And as other physicians fled private practice for hospitals or have been gobbled up by private equity firms, most pediatric ophthalmologists remain in private practice.

Unfortunately, the factors that make the specialty uncommon have also made pediatric ophthalmologists and their patients uncommonly vulnerable to the ravages of the COVID-19 shutdown.

A survey conducted by the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) shows that pediatric specialists are struggling to keep their practices viable in the wake of the shutdown. As a result, children in America may suffer medical outcomes not anticipated in first-world countries.

AAPOS conducted the survey of its members in April, one month after the shutdown, to assess the effects of the pandemic on private and institutional pediatric ophthalmology practices. The results are sobering and portend access-of-care issues for children with blinding conditions and life-threatening diseases.

While all sectors of pediatric ophthalmology were affected by the reduction in patient volume, private practices were the hardest hit. Among the survey's findings:

• Practice revenue was only 13 percent of usual, across all practice types.
• 10 percent were considering bankruptcy, nearly all of whom are in private practice.
• More private practice physicians than employed hospital and academic physicians (27 percent vs. 7 percent) expressed plans to limit Medicaid patients.
• 9 percent said they planned to retire earlier.

This is an alarming, important and pivotal moment in the history of medicine. We appeal to the legislative bodies to support pediatric ophthalmologists to champion eye health and vision of our most valuable commodity – our children."

Shira L. Robbins, MD, Professor of Ophthalmology, Shiley Eye Institute, University of California-San Diego

Dr Robbins the survey effort.

Dr. Robbins stressed that pediatric ophthalmologists have limited access to federal financial assistance programs because the assistance is based on treating elderly Medicare patients, while other assistance programs have left many fixed practice expenses uncovered and only partially covered staff and physician salaries.

AAPOS conducted a follow-up survey in July to gauge the extent of the recovery since the initial shock of the April shutdown. While it shows some improvement, many pediatric ophthalmologists continue to struggle to remain in business. Dr. Robbins predicts that as the pandemic continues, so will the strain on the delivery of medical care. Among the topline results:

• 3 percent of practices are closing permanently
• At least twice as many practices plan to limit Medicaid compared with pre-COVID levels
• 5.4 percent are considering or have declared bankruptcy
• 42 percent feel their practice viability remains "day to day" with bankruptcy as a possible outcome
• 52 percent experienced a salary reduction
• 26 percent received less than $1,000 from the first round of assistance from Health and Human Services
• 51 percent continue to operate with reduced staff compared to pre-COVID levels
• 91 percent expect further staff reductions (up to 25 percent) following completion of Paycheck Protection Program (PPP) loan requirements

"Pediatric ophthalmologists are rare medical subspecialists with the majority working in private practices," said Kathy Lee, MD, PhD, president of AAPOS. "Without continued governmental financial support, many will not be able to sustain their practices contributing to an even greater access problem for children with eye problems."