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Feature

Analysing the latest data of optometry supply in Australia

02/09/2019By Callum Glennen
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The correct number of optometrists needed is constantly debated, but a new report makes a strong case there will be future shortages. CALLUM GLENNEN looks at the methodology behind the analysis.

With the launch of several new optometry courses and subsequent increase in practitioner numbers, it is undeniable that the eyecare sector’s workforce is getting larger. However, whether the current rate of growth will keep pace with the factors impacting demand, such as Australia’s ageing population and worsening eye health, is still unclear.

Deloitte Access Economics’ (DAE) report Optometry Workforce Report: 2018-2037, commissioned by Specsavers, warns that Australian optometry is currently on the brink of an undersupply crisis. It cautions that if left unchecked, every state and territory, with the exception of the ACT, will soon suffer a shortage of practitioners.

Background to the report

This new study builds upon DAE’s previous efforts to develop a large-scale model of Australia’s optometry workforce. The firm – then known as Access Economics – has researched the profession for more than a decade and completed two previous studies; one on behalf of Luxottica in 2006 and a second in 2011 commissioned by Specsavers. Both reports identified excess demand in the Australian optometric market, with shortages of optometrists forecast to be particularly acute in rural areas.

As part of the most recent study, DAE also undertook a review of Optometry Australia’s (OA) 2015 projections, which indicated a regional shortage of optometrists in the Northern Territory, South Australia (prior to 2021) and Tasmania (prior to 2031), but a general oversupply across the country as a whole.

Several elements of the eyecare market have since changed. In particular, DAE highlights the 2015 shift in policy that resulted in people under 65 becoming eligible for a Medicare-funded comprehensive eye test every three years, and annually for those aged over 65. Previously it was every two years for both categories. Australia’s ageing population, which is leading to more people suffering age-related conditions, is also placing added pressure on the sector.

There have also been changes in the general market. At the beginning of 2008, there were no Specsavers stores in Australia, however the chain now performs more services annually than the entire market modelled by Access Economics in 2006.

Victoria and NSW are currently estimated to have an oversupply (1 and 34), however every region except the ACT will suffer worsening shortfalls from 2023 onwards

 

Supply vs Demand

The balance of supply and demand is difficult to measure. Growth across both the use of optometry services and Medicare expenditure is affected by both supply and demand, preventing either of these measures from being a complete illustration. The report cautions that there is no robust metric to assess demand or supply separately, meaning levels need to be inferred from factors such as waiting lists, optometrist salaries and job advertisements.

The methodology used to calculate supply looked at the current number of registered optometrists, reducing the data to a number of full time equivalent (FTE) optometrists based on the average hours worked. Weekly hours were found to vary significantly between individual practitioners due to factors such as age group, gender and location. As such, the 5,349 optometrists registered by with the Optometry Board of Australia in 2018 was calculated to be the equivalent of 4,114 full time practitioners.

At current levels, and accounting for the projected number of people entering and exiting the sector driven by factors such as new graduates, immigration and retirements, the number of FTE optometrists in Australia is forecast to increase to 6,653 by 2037.

On the other side of the scale, demand was estimated by collating data from several sources including Medicare Australia, the Department of Veteran’s affairs and population projections from the Australian Bureau of Statistics. Australia’s population was categorised by both demographic and type of care.

The above chart shows Australia's number of FTE optometrists is predicted to increase by 2,539 over the next 18 years. A significant increase of practitioners under the age of 35 is reflective of the country's new optometry schools

 

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Major shortfall

The report’s authors used this to estimate service utilisation per 1,000 people, and projected the use of services through to 2037 in five separate ways including income growth, historical growth and linear regression.

“Overall, the number of FTE optometrists demanded was projected to grow from 4,234 in 2018 to 7,841 by 2037, which does not include any changes in the scope of practice over the same period,” the report reads.

Ultimately, DAE estimates that there is currently an undersupply of 120 FTE optometrists, and if trends continue there would be a major shortfall of 1,188 by 2037. Factors such as high and rapidly growing remuneration rates for optometrists, large numbers of advertised vacancies receiving no applications and low unemployment rates compared to similar occupations illustrate the current level of undersupply.

Addressing OA assertion that the sector is currently facing an issue of oversupply, the report notes that discrepancies exist between what is assumed to be the duration of a given service: “…as both demand and supply are ultimately measured in clinical hours, the amount of time taken per service is of considerable importance. Unfortunately, there is no ‘official’ duration for any given service, and estimates vary substantially,” the report states.

The research suggests that the relatively short durations used in the OA-commissioned work results in estimates of an oversupply of clinical hours. The figure used in their most recent modelling was 30 minutes for an initial consultation, and 20 minutes for ‘other’ consultations.

DAE utilised a larger estimate, based on results from a 2006 survey and proportionally weighting them to match current demand and supply for hours, assuming equilibrium in the 2016-17 financial year. This placed an initial consultation closer to an hour, with other services ranging between 20 minutes for a follow-up to 80 minutes for contact lenses, while acknowledging appointments vary greatly.

What is not accounted for is whether all clinical hours supplied are actually being used. Optometrists are unlikely to fill their appointment book every day, and loyalty is likely to prevent some patients from moving to a quieter practice. This suggests that even if national or regional supply issues are matched, there still may be localised shortages in some locations.

This chart shows that Australia's ageing population will result in greater demand among older generations, resulting in a need for more than 3,600 additional optometrists

 

Regional divides

Another key finding is that the shortage of optometrists vastly differs between regions, creating issues of maldistribution across the sector.

DAE predicts that the number of FTE optometrists is expected to increase by 73% in capital cities by 2037, but in regional areas numbers are only expected to grow by only 37%. Specsavers’ data, which contributed to the report, found that approximately 76% of graduates were employed in urban areas.

Over the same period demand in urban areas is expected to outstrip supply – by 90% in urban areas and 76% in regional areas – over the next two decades. The population in urban and regional areas is predicted to grow by 36% and 18% respectively between 2018 and 2037.

Additionally, it is predicted that Australia’s states will be affected very differently. The ACT is the only region expected to see a surplus of optometrists, while NSW and Victoria are predicted to develop an undersupply. Australia’s more remote and sparsely populated regions, such as Tasmania, WA and the NT, are believed to already have an undersupply issue that will continue to worsen.

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