A dynamic simulation model was developed to project future eye care visits and workforce requirements under different sc
Workforce planning for eye services in Singapore John Ansah, Duke-NUS Dirk de Korne, SNEC Steffen Bayer, Duke-NUS Pan Chong, SNEC Andrew Phua, Duke-NUS Thiyagarajan Jayabaskar, SNEC Desmond Quek, SNEC
INTRODUCTION
FUTURE SCENARIOS: EYECARE VISITS
• Singapore is aging rapidly – in 2050, 31% of the population will be 65+. • prevalence of eye disease increases among the elderly. Hence, eye service burden in Singapore is projected to increase substantially by 2040. • To provide eye care services, accurate projections of disease burden and resource need is required. • A dynamic simulation model was developed to project future eye care visits and workforce requirements under different scenarios.
DATA • Administrative patient service data (SNEC) • Singapore Epidemiology of Eye Disease (SEED) Study (SERI) • Extensive discussions with ophthalmologists, healthcare planners, and expert estimates.
• To project future prevalence of eye diseases, age and ethnicityspecific prevalence data from the SEED study were applied to a simulation of the future population. • A simulation model was developed to project the number of future eye care visits, the number of eye care professionals and ophthalmology training places required to meet this demand under different scenarios. Ophthalmologists Supply Model
total desired medical officer fte
Clinical FTE medical officer
desired medical officers
desired medical officer hiring
AdjustmentTime attrition MO
Medical Officers
House Officers
estimated desired specialist
desired ophthalmologist hiring
MO hiring
Desired Ophthalmologist Admin FTE
becoming HO dropOut
residency admission MO
residency admission HO
residency admission MDS
residency admission
Ophthalmology Residents
graduates to other jobs
other residency
fraction other residency program
Ophthalmologist Gap
Clinical FTE Ophthalmologist
Ophthalmologists Attrition
graudates hiring
Research FTE
Attrition Rate Specialist
Teaching FTE
time to adjust gap
required residents
weighted clinical FTE specialist
clinical FTE Ophthalmology Educators
desired Ophthalmologist per resident
residents gap Ophthalmology educators
desired ophthalmology residents
Ophthalmologist training requirement for other hospitals/clinics
RESULTS: BURDEN OF DISEASE By 2040 (compared to 2014): • No. of people who ever had a cataract will increase >90% • No. of people with glaucoma or age-related macular degeneration will increase >104% • No. of people with diabetic retinopathy will increase by about 63%.
Thousands
1400000
Combined
Cataract Glaucoma Myopia ERM
Business as usual
1000000 800000
New model of care
600000 400000 200000 0
• Under the business as usual scenario the eye care workforce needs to be more than doubled. • The workforce requirements increase substantially with an increased uptake rate. • Changes in the model of care lead only to slight decrease in requirements (assuming there is no change in uptake rate). Increased New model Combined Workforce Base case uptake of care scenario scenario scenario
medical officer gap
AttritionHO
1200
Increased uptake
1600000
FUTURE WORKFORCE NEEDS
Attrition Rate HO
1400
1800000
1200000
METHOD
Medical Students medical school admission
We compared 4 different future scenarios for eye care visits: 1. Business as usual: Future eye care visits based on current prevalence and population growth rates. 2. Increased uptake: Eye service uptake rate doubles (e.g. due to increased awareness, changes in cost/accessibility or more widespread screening) 3. New model of care: Implementation of integrated eye care model, where 20% of DR and glaucoma cases, and 90% of refractive error cases/myopia are decanted to Primary Eye Care Clinics. 4. New model of care with increased uptake.
DR AMD Undercorr. Refractive Error RVO
1000
2020
2040
2020
2040
2020
2040
2020
2040
Ophthalmologists
162
255
233
396
148
235
211
362
Medical Officers
40
64
58
99
37
59
53
91
Optometrists
58
92
84
142
53
84
76
130
Registered Nurses
280
442
404
686
256
407
366
628
Enrolled Nurses
125
198
181
307
115
182
164
281
Technicians Ophthalmic Assistants
53
84
76
130
49
77
69
119
100
157
144
244
91
145
130
224
DISCUSSION
800 600 400 200 0 2000
2005
2010
2015
2020
2025
2030
2035
2040
• Alternative models of care delivery and service uptake will modify these workforce requirements in the future. • Due to the large, currently untreated eye disease burden, changes in the uptake rate can easily overwhelm the current system. • Interventions which might change uptake rate require pro-active increase in training to meet anticipated demand of ophthalmologists as training takes 5 years.
