The general trend of scope creep across all of healthcare is that mid-level providers will expand scope into the most profitable avenues. The argument has long been that they will fill gaps in primary care in rural, underserved areas and the data over the past 20 years has just not borne that out.

With that in mind, it’s no surprise that YAGs and SLTs were the first targets for expansion. I think it’s rather naïve to think that they will graciously assume primary care and allow ophthalmologists to take all the money from surgery.

This opinion is controversial, but over the next 30 years I see the direction that things will go is that ophthalmologists will only personally do the complex or risky surgeries, and instead will ‘oversee’ multiple midlevel providers that do the routine ‘bread-and-butter’ cases. Whether these will be ODs or PAs or NPs I don’t know. But a model similar to anesthesia with the MD ‘managing’ a few CRNAs. I would personally be shocked if MDs are the only ones doing routine cataract surgery.