1800 additional registrants to bring the ratio up to the BirchardElliott minimum of 11.3/100,000 or 7200 additional registered optometrists to reach the 14/100,000 level, or over 17,000 more registered optometrists to reach what is considered the ideal level of 18.9/100,000 if about 26% of the registrants are not actually practicing and if the personal economic factor is removed. These figures are so large as to be almost unbelievable, yet their derivation is sound and conservative. They are further substantiated by the experiences of the U.S. military services where the personal economic factor is no longer a barrier to adequate vision care, and by the ratios existing in Great Britain where a National Health Service has been in effect since 1948. That a severe shortage of optometrists presently exists in the U.S. simply cannot be denied on any rational basis; the only debatable point is the actual magnitude of the shortage. Population Growth In 1950 the U.S. population was slightly over 150 million. By 1970 it will have exceeded 200 million. Increases have ranged from a low of about 2.25 million per year to a high of about 3.1 million per year, with an average of about 2.65 million per year for the total 20-year period. To maintain a constant ratio of optometrists to population requires a production rate in keeping with the changing population. Here again, as in the previous section, there is leeway in judging what ratio is desirable. If we consider that the 1952 ratio of about 14 registered optometrists per 100,000 population is the desirable one, as most professional optometric organizations maintain, then about 368 additional new optometrists per year would be required just to match the increase in population. If we choose the ratio of 11.3/100,000, derived from the ultra-conservative estimates of Birchard and Elliott, the number of new optometrists required each year just for the population growth would be 299. And even if we use the present--and admittedly wholly inadequate--ratio of 10.4/100,000, this would still require an average of at least 276 graduates per year just to care for the increase in population. For purposes of discussion we will adopt as a compromise the rounded figure of 350 new optometrists as the number needed for the average populational increase of 2.65 million per year. This represents a ratio of 13.2 registered optometrists per 100,000 population. Summary of National Manpower Requirements In the foregoing sections we have considered two main aspects of the national optometric manpower situation; (1) the ratios of production and attrition, and (2) the total number of optometrists required to provide adequate vision care to the public. Although the production rate of optometrists undoubtedly reached excessive heights during the late 1940's and early 1950's which produced problems in the assimilation of so many new optometrists in such a short time, the overproduction simply compensated for a long previous period of undersupply, so that the result was that the number of optometrists in the nation rose to an adequate but probably not excessive level. The attrition rate has exceeded the production rate ever since that time, so the actual number of registered optometrists has continually declined. With a steadily growing population, the ratio of optometrists to population has become increasingly more inadequate. Since 1954, attrition of registered optometrists has averaged 499 per year while the number of optometry school graduates has averaged only 387 per year--a net loss of 112 optometrists per year over that 15-year period. During the same period the U.S. population has increased at a rate of more than 2.65 million people per year, a rate which would require about 350 additional O.D.'s per year merely to care for the increase in population. Thus we can conclude that the graduation of new optometrists during the past 15 or so years has fallen at least 462 per year short of the minimum number needed for the nation. The average graduation of 387 optometrists per year during this 15-year period has supplied only about 45% of the number of new optometrists actually needed to maintain a minimum adequate number of registered optometrists for the growing U.S. population. Just to compensate during the next 15 years for this deficiency of the past 15 would require a graduation rate of 1311 per year (849 + 462). However, the attrition rate throughout the coming 20 years or more will be increased by an average of about 170 per year as the optometrists from the post-war overproduction period reach retirement. Hence a conservative estimate of the minimum number of new graduates needed from now through 1985 or 1990 is at least 1485 per year. As an indication of the relative conservativeness of this estimate, it can be compared to the latest estimate by Mote that 20,361 new optometrists would be needed by 1980 to meet the needs imposed by growth and attrition. For an 11-year period represented by his projection, this would average 1851 graduates per year. Enrollment Trends The total numbers of students enrolled in all of the U.S. optometry schools since 1950 are shown in Table 4. In view of Sources: Health Resources Statistics 1968, U.S. Public Health 1Mote, Herbert G., Analysis of Optometric Needs by States to 1980, The Ohio State University, 1969 (mimeo). ་ ས our previous discussion of the present shortage of optometrists and the inadequate average rate of production of new optometrists since the mid-1950's, the upward trend in enrollments since 1960 is encouraging. However, even though the total number of students has risen almost to the level reached in 1950-51, it still remains far short of the number need to supply the nation with adequate optometric manpower. In 1950 the standard optometric program consisted of 3-years of professional courses after completion of a 2-year pre-optometry program. Today the professional courses in all schools of optometry require 4 years. Most of the schools changed from the 3-year to the 4-year program since 1963, so a considerable part of the upward trend in enrollment throughout the 1960's is due simply to the retention of optometry students in school for an additional year. To produce the approximately 1481 graduates per year that we have estimated are needed as a basic minimum, would require a total enrollment of about 6300 or more students in the four-year program. The total of 2200 optometry students in 1968, even though it was the highest enrollment in the past 16 years, still was only about a third of the minimum number needed. Because some schools have only recently changed from a 3-year to a 4-year professional program, the upper classes are not all filled to capacity, so the enrollment picture can be expected to improve rapidly in the next year or two. First-year enrollment in 1968 totalled 781 and was very near the maximum capacity of the schools at that time. Several schools are in the process of expanding their facilities and one new school is being established in 1969. But even if the average class size for all schools of optometry is increased to 90 and if all four classes in every school are filled to capacity, the total enrollment capacity in optometry for the entire U.S. will still only be approximately 4000 students--less than two-thirds the number actually needed. To meet the nation's minimum needs in the supply of optometric manpower would require an immediate increase of some 70% or more in the nation's optometric educational facilities. The inevitable delay in developing such increased facilities will only increase the present shortage and require even greater expansion to compensate for the accumulated deficit. |