Strabismus surgical subspecialization: a population-based analysis

Importance — The growing complexity of medical and surgical care has resulted in increasing subspecialization. To date, data have been lacking regarding the degree to which subspecialization has affected the provision of strabismus surgical services. This gap is important to address given the implications for healthcare human resources planning and educational programs.

Objective — To investigate the effect of subspecialization on the provision of strabismus surgery services.

Design, Setting and Participants — Population-based study in Ontario, Canada, which provides universal healthcare coverage to the provincial population. Participants included all ophthalmologists in Ontario and the provincial population of approximately 12 million persons from January 1, 1994, through December 31, 2011.

Main Outcomes and Measures — Surgeon-level rates of strabismus surgery

Results — From January 1, 1994, through December 31, 2011, the percentage of ophthalmologists who provided strabismus surgery decreased from 37.7% (156 of 414 surgeons) to 12.5% (54 of 432 surgeons; difference, 25.2%; 95% CI, 19.3%-30.9%; P < .001), a 66.8% decline from the baseline level. Of ophthalmologists who provided strabismus surgery during the same period, the mean number of strabismus procedures per surgeon grew from 16.2 to 55.3 per year, a 241.4% increase (95% CI, 20.4%-461.6%; P < .001). These trends occurred at all career stages.

Conclusions and Relevance — Strabismus surgery has evolved into a subspecialized field of ophthalmology during the past 15 years. These findings may have important implications for healthcare professionals and healthcare system leaders, including the need to account for subspecialization in physician human resources decisions to ensure access to quality strabismus surgery across regions. Furthermore, residency education programs and their governing organizations may need to account for strabismus subspecialization when designing curriculum and accreditation requirements.