Australia’s optometry workforce debate often defaults to maldistribution and the idea that we have enough optometrists but in the wrong places. Although regional access gaps are important, an overemphasis on maldistribution risks policy responses that are disproportionate to the problem.
Recent proposals to establish new optometry schools in regional Queensland and the Northern Territory exemplify this, assuming redistribution will follow expanded training capacity.
Although such measures may incrementally improve local coverage, they would very likely exacerbate national oversupply.
A more proportionate starting point for workforce planning is publicly available government data on workforce size, geographic distribution, and service utilisation. In particular, the National Health Workforce Dataset (NHWDS), derived from Ahpra registration data, captures the vast majority of practising optometrists and shows where optometrists actually work, without the selection bias of low-response surveys.
I collated and analysed these in an open-access dashboard, including detailed breakdowns by Primary Health Network (PHN) and Modified Monash Model rurality (MMM). A practical measure of access is population coverage, defined as the number of people served per full-time-equivalent (FTE) optometrist (Figure 1).
Using 1 FTE per 10,000 people as a practical benchmark for sufficient access, Australia demonstrates broad coverage with geographically localised shortfalls.
Under this threshold, all 31 PHNs and most MMM categories meet or exceed sufficient coverage. Residual gaps are largely confined to MM5 (small rural towns) and MM7 (very remote communities), with a combined national shortfall of ~48 FTE optometrists.
Coverage trends further suggest that maldistribution is narrowing. Workforce growth has recently been faster in non-metropolitan regions (~+5.2%/year) than in metropolitan regions (~+4%/year), while population growth has been stronger in metropolitan areas (~+2.6%/year) than non-metropolitan areas (~+1.1% year).
If these trends persist, the metro–non-metro coverage gap may converge around 2042.
Oversupply biggest issue
In contrast to maldistribution shortfalls measured in the tens, oversupply is measured in the thousands.
Oversupply can be estimated as the difference between supply capacity (clinical hours worked) and observed service utilisation (Medicare-billed hours). Using methods consistent with, and updated from, the Optometry Australia-commissioned workforce projections report, current modelling indicates a net oversupply of ~3,000 FTE clinicians.
In this context, advising clinicians to “move out of metropolitan areas” does not resolve a structural imbalance of this scale.
Oversupply places downward pressure on hours, employment conditions, and career progression, and may incentivise service models driven more by throughput than clinical need.
On the positive side, it has also narrowed many geographic gaps by increasing clinician density across regions.
The central argument, therefore, is proportionality. National workforce planning should prioritise addressing oversupply in the thousands, rather than focusing on maldistribution that manifests as localised shortfalls in the tens.
What will fix oversupply?
Addressing oversupply requires action on two fronts. First, inflow should be moderated.
Reducing graduate numbers is uncommon outside medicine, but at minimum the profession should reject the opening of more optometry schools. Supply growth should not be the default response to small, localised access gaps.
Second, funded demand for optometrist time must increase. Expanded, appropriately governed roles in hospitals, and urgent- and chronic-care aligned pathways, would create sustainable career pathways.
Pharmacy offers a contemporary Australian example of job creation through funded scope expansion.
During and after COVID-19, pharmacists took on large volumes of additional, reimbursable work, including vaccination delivery and funded assessment/prescribing for urinary tract infections and selected chronic conditions.
Importantly, additional remuneration must follow, and this is where industrial bargaining and union leverage can improve pay and conditions.
Overall, the data suggest that oversupply (not maldistribution) is the primary constraint on workforce sustainability.
Of course, this is all much easier said than done. I am hoping that with renewed direction at Optometry Australia, alongside the growing role of the Health Services Union in representing optometrists, that there are opportunities for these bodies to work together to align workforce planning with service need and sustainable employment conditions.
ABOUT THE AUTHOR
Name: Matt Trinh
Qualifications: Clinician-researcher with particular interests in advancing retinal imaging, statistical modelling, and clinical
ophthalmic practice.
Affiliations: Independent.
Location: Newcastle.
Years in industry: 14.
