able to practice occasionally, and in such cases they might consider themselves in part-time practice, but that does not appear to be the situation here. 1 of four other states where information about age distirbutions of registered optometrists had been gathered in recent years and was available for comparison, only one (Ohio) showed a fairly clear indication of a similar high retention of registrants beyond about age 70. For none of the four states was information available as to what proportions of the older registrants were actually still in full-time practice. However, in reporting on the number of practicing optometrists in New York in 1964, the Secretary of the State Board expressed his concern over the inordinate number of New York-licensed optometrists in their 70's, 80's, or even 90's, who claimed to be currently practicing. 2 For Missouri, the fact that such a large number of its practicing optometrists are over 65 years of age must be of special concern in assessing the needs of the immediate future. This group obviously cannot be relied on to continue to provide a significant share of the vision care for the Missouri public for more than a few additional years. Whether the group that follows them--now in their 50's and 60's and approximately equal in numbers to the post-65 group--will be so willing to forego retirement is doubtful. E ང C Out-of-State Registrants Of the 619 optometrists holding Missouri licenses in May 1969, 124 (20%) were residents of other states and therefore not actually part of the optometric manpower of Missouri at that time. Presumably the annual renewal of their Missouri registrations indicates that they still at least entertain the 1california, data of Peters and Kleinstein, op. cit.; Ohio and New Jersey, data gathered by H.G. Mote, Ohio State University, 1966; Michigan, data provided by Michigan Optometric Association. 2Letter from A.P. Jones, Secretary of State Board of Examiners in Optometry, to Dean E.K. Fretwell, Jr., City University of New York, January 4, 1965. possibility of someday returning to Missouri. Of the 124, 12 are retired and 6 are engaged in other occupations, so their is little likelihood of a return to Missouri practice by a significant number of these. The age distribution of the remaining 106 who are practicing in other states but maintain Missouri registration as well, is rather surprising. It might have been expected that this group would be made up mainly of young optometrists who took State Board examinations in two or more states after graduating, while still undecided on a choice of practice locations, and who have retained their Missouri licenses for a few years while becoming established in the states they finally chose. If that were the case, the possibility that some of them might be persuaded to return to Missouri could be regarded as reasonably good, and this pool of registrants could be regarded as a potential source of additional Missouri practitioners. The age distribution table clearly indicates that this is not so. Allowing for the smaller numbers in each age category, the distribution of ages is not markedly different from that of the in-state registrants except for a near-absence of any out-of-state registrants older than 70. Since optometrists rarely move out of a community after having spent several years in becoming established there, it would not appear that a significant number of the out-ofstate registrants could be considered as prospective additions to Missouri's optometric resources. Military Optometrists Newly graduated or recently established young optometrists may be called on to satisfy their military service obligation, and most, but by no means all, will then return to practice in their home state where they have an optometric license. Thus in a tabulation of a state's manpower resources, the military optometrists may be considered as a reserve supply, some proportion of which will likely be added to the state's complement of active practitioners in a few years. This includes those who have decided on military careers but are approaching the age of retirement from the armed forces by now, and who may return to their home state to enter practice as a second career. There are only 10 Missouri registrants in military service, and only 9 of those are below 35 years of age and presumably satisfying their military obligation. Some of these may elect to remain in the military forces, others may choose to establish practices in other states. It would be unsafe to predict that more than 4 or 5 of them will become Missouri practitioners in the next few years, Of the older military optometrists, only 4 can be close enough to military retirement even to be considered as potential additions to Missouri's optometric manpower in the next decade. Thus, the military optometrists licensed in Missouri cannot be regarded as a reserve manpower pool of significant magnitude. Analysis of Missouri's Practicing Optometric Manpower To provide optometric services to the Missouri public required active optometric practitioners within the state. We have concluded in the previous sections that the out-of-state residents and the military optometrists who hold Missouri registrations do not constitute a significant source of additional optometric practitioners for the state. We therefore will summarize Missouri's present optometric manpower situation as follows: There are 477 registered optometrists residing in Missouri, but and This leaves But so there are but which leaves 441 practicing optometrists in Missouri. 26 were only in part-time practice 415 full-time practicing optometrists in Missouri, 49 of them are 70 years or older, 366 full-time practitioners below age 70. 23 of these are 65 to 69 years old, so only 343 full-time practitioners are below age 65. Thus to provide optometric services for a population of some 4.8 million there are now, at best, about 441 practitioners (9.2 per 100,000). This population ratio, although much lower than desirable, is not far from the probable national average and may even exceed it. The primary cause for alarm is the fact that over 20% of the practicing optometrists are age 65 or older. Were these post-retirement-age practitioners to retire, Missouri would be left with only 7.3 optometrists per 100,000 population to furnish the needed vision care. Length of Practice The fact that so many Missouri optometrists are of advanced age suggests that Missouri optometrists may practice considerably longer than the national average, estimated as about 32 years. Figure 7 shows the year of licensure for the 441 optometrists practicing in Missouri in May 1969. The great peak extending from 1947 to 1952 is no surprise, but it dramatically illustrates the source of Missouri's present-day optometric strength and potential future weakness. The other, even higher, peak in 1921 is readily accounted for by the fact that 1921 was the year in which Missouri's newly enacted Optometry Law went into effect, requiring registration of optometrists for the first time. Some optometrists who had been practicing prior to 1921 apparently delayed their compliance with the new law until as late as 1927 or 1928, which accounts for the secondary hump of licensures in those years. Judging from the average rate of licensures through the 1920's and early 1930's, the 1921 peak would appear to represent the accumulation of some 20 years or so of beginning optometrists, and indeed it is possible that the three oldest optometrists still practicing in Missouri (full-time) at the ages of 84, 86 and 87, may have begun as young apprentice optometrists at just about the turn of the century. In any case, these data show that about 14% of the practicing optometrists in Missouri have been in practice for at least 48 years, and over 25% have exceeded the estimated national average of 32 years in practice. Considering the imbalance produced in such percentage calculation by the relatively huge numbers of optometrists licensed just 18 to 21 years ago, these |