Declining field of pediatric ophthalmology.

Most of us who have been pediatric ophthalmologists for many years cannot help but notice the significant trends that have occurred in the number of residents choosing this field to practice. In 1994, 42 of 43 fellowship positions were filled. In 1997, only two fellowship positions were not filled. However, by 1999, the match rate slipped to the current level with 11 of 38 fellowships remaining vacant. Pediatric ophthalmology currently is not as popular as other subspecialties with residents seeking further training. In this issue, Hasan et al. attempt to outline the reasons why there are fewer residents going into pediatric ophthalmology and what might be done to reverse the trend. The authors reported that one of the reasons for fewer residents choosing pediatric ophthalmology was because pediatric patients were too difficult to examine. However, an aversion to examining children would not explain why so many fellowship positions in pediatric ophthalmology are vacant today. Is it that ophthalmology residents liked working with children in the past but suddenly dislike the idea of treating them now? This sentiment is probably a constant variable over time. The second reason for ophthalmology residents not choosing pediatric ophthalmology fellowships is because of lower financial compensation. This factor may be the most compelling. Pediatric ophthalmologists are compensated the lowest among all ophthalmology subspecialties. Why does strabismus surgery get reimbursed less than cataract surgery when it takes the same amount of time, if not more? Restructuring reimbursements for pediatric ophthalmology procedures is complicated and difficult both politically and legally. However, effective legislation to improve the compensation for pediatric ophthalmologists would certainly renew the interest in this subspecialty and improve the future of children’s eye care in the United States.