This issue RANZCO discusses why there are less ophthalmologists working outside the city and the importance of specialist ophthalmologists working closely with the local optometrists.
Over the last six months I have travelled to all RANZCO branches in Australia and New Zealand, except Tasmania, which I’m saving for our Congress in November.
It has been good to meet many ophthalmologists and listen to their concerns about practising in the current environment. One of the recurring themes is our relationship with optometrists. Almost without exception, every ophthalmologist I have spoken to has good working relationships with optometrists in their local area, or in the towns they visit.
This is encouraging – we all need to work together to ensure Australians receive the best eye-care possible. I remain surprised that there is such a strong push by AHPRA and the OBA and some optometrists to diagnose and treat glaucoma independently of ophthalmologists. I believe some optometrists are quite surprised by this as well.
I know that RANZCO and the Australian Society of Ophthalmologists (ASO) have been receiving emails of support from optometrists for the action we are taking against the OBA. The most frequent comment is “this is a tricky and insidious disease that needs careful and collaborative management”. I remain hopeful that the OBA will revert their guidelines to the previous arrangement before relationships between ophthalmology and optometry are further damaged.
The fact that so many ophthalmologists are working in country towns and remote areas is not really surprising, but I have found the level of coverage to be much greater than I had expected. I think this reflects the obligation most ophthalmologists feel towards providing quality eye-care to all Australians and New Zealanders.
I have heard there are not enough ophthalmologists in country areas, and it is true that a permanent practice outside the capital cities is now less common than years ago; what has changed is the frequency of travelling ophthalmologists. Some country areas are likely to have better access to an ophthalmologist than the periphery of cities.
Health workforce is a big issue in all areas, not just eyes. The apparent solution is to train more people or get someone similarly qualified to do the work. I do not think, however, that this is necessarily the solution because it doesn’t address the actual needs of different communities.
A big part of the reason there are less ophthalmologists outside the city is that over the last decade or so ophthalmology has, like all other medical specialties, become more sub-specialised. Although RANZCO trains generalist ophthalmologists, most do a few years of Fellowship training in an area of interest. It can then be difficult to maintain an appropriate skill set if an ophthalmologist is forced back into general work by moving outside a major centre. The more appropriate solution is the one that has developed over time, that being a steady rotation of specialist ophthalmologists working closely with the local optometrist or GP, or taking advantage of new technologies such as telemedicine.
The use of telemedicine in ophthalmology is still in its infancy, but some initial trials show promise. The issues are around an appropriate reimbursement system for the consultations, and having experienced people at the patient end to take good pictures. Again this is an area that requires a collaborative approach by ophthalmologists and optometrists. The whole eye care system is a rapidly evolving space when it comes to the use of technology, and most people (practitioners and patients) are keen to use the latest gadgets. We know optometrists have much of the gear required, but how do they get paid for taking a picture and transferring it to an ophthalmologist? How does an ophthalmologist get paid for spending an appropriate amount of time reviewing data, talking to the optometrist and possibly the patient?
As the trials progress we will learn more about how effective telemedicine may or may not be for ophthalmic work, but I suspect the limiting step is going to be changing the mindset of those in charge
of funding arrangements.
Dr. David Andrews is CEO of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO). Dr. Andrews brings extensive experience to his role, having previously served as an executive in a number of medical related companies and most recently as Chief Operating Officer of the Woolcock Institute of Medical research.
Dr. Andrews holds a PhD in agricultural chemistry and an MBA. For more information on RANZCO go to: www.ranzco.edu