All right. Welcome everyone to another episode of the innovators podcast from AI and I care sponsored by Jopsen. I am so delighted today to have Dr. Richard Edlow, who is very well known to most, if not all of our audience as the economist.
I've been following your work for many years now. And I love when you, I love your writings and your musings. And it's been a while from me trying to get you on. So I'm so glad you could join us today.
Yeah, I'm thrilled to be a part of this. You and Scott Mars have just done a phenomenal job of introducing the I care industry to artificial intelligence and what it means for all of us. So I'm thrilled to be a part of this program. So I know you, you're a retired opt-on, Trist, for, and you ran a very, very large group as CEO.
I kind of walk us through where I care has been. I mean, sort of give us a little history of where I, where's I care in your mind? Where's I care been? Where is it right now?
And sort of where do you think it's going? Sort of just maybe just to set the stage for our conversation sort of large themes. And then we could go from there. Yeah, it's really, it's interesting as I look at the industry, my background is, is a clinician, my background as a business person, my background with a degree in economics.
I'm just a numbers geek in general. So I've been tracking data within our industry for years. And it's interesting the way you ask the question because probably 20, 30 years ago, my thought was independent private practice did not have a future. I'm a complete 180 from that nowadays.
I've never been for the industry as a whole, an independent practice in in specifics. I've never been so bullish on our industry on the I care industry. And this is all three O's, optical, optometry, ophthalmology, all three O's. The the growth rate, again, I'm a numbers geek.
So the average gross domestic product grows in the US for the past 10 years, maybe two to an half percent a year. And the growth in the I care industry is about 6% a year. So double the GDP. And for a whole slew of reasons, a big part of it, as we'll talk about, is the demand for age-related I care and how that's growing and why artificial intelligence, I believe, is going to be the solution to some of the increasing demand on the workforce.
I really believe that that's one of the encouraging things. For the industry as a whole, it's growing phenomenally. The future for I care is phenomenal. For optometrists and for ophthalmologists coming out of the practice, completing residencies, completing programs, there's never been a better time to practice the opportunities about us.
But having said that, with the challenges of a limited workforce and huge increase in demand, I'll share some numbers with you. It's incumbent upon every moment in the industry to figure out some smart solutions to how we grow. I mentioned how I care as a whole industry. I crunch these numbers together every year of everything from optical to surgical, amateur surgical facilities, diagnostic testing, Medicare exams.
I track all that and as I was saying, it grows about 6% a year. But also at the same time, if we look at the last 10 years, the last 10 years in the US, the consumer price index grew, I think it's like 37% over the 10-year period, so 3.5% a year, let's say. There's an I care index that the Bureau of Labor Statistics tracks, the I care index, did not grow 37% like the CPI, it only grew 19%. So here we have this huge increase in demand for I care, a shortage of providers, more so an ophthalmology than optometry, but a shortage.
Yet, our pricing structure isn't even keeping up with the inflation rate. So we've got a lot of challenges. Now, we're all pretty fairly intelligent human beings and the net incomes for both optometry and ophthalmology during this period of time when the CPI is exceeded, I care index has grown has grown nicely. So most of our colleagues are pretty clever in figuring it out.
But what I like to do is I look at the macro view, I look at the large view across the US of the increase in demand for exams, look at the supply of optometrists and ophthalmologists. I look each year I update how many ophthalmologists completed the residency program, how many optometrists came out of an optometric program, and then how many exited each of the fields. And in optometry, optometry is growing about 1.2% a year, 1.2% a year. And there was a study about a year and a half ago in ophthalmology, ophthalmology is declining, 0.8% a year.
Yet the demand for age-related eye care, we all know everyone 65-year-old has something going on in eye-wise. Demand for age-related eye care is increasing about 2.5% to 3% a year, far exceeding the supply of providers. So what are we going to do? That's where AI comes in.
And that's where you guys have been doing such a great job of tracking what's going on in the industry. And it's imperative that we embrace it. It's imperative that whether it's an AI scribe in the exam room or AI evaluating diagnostic, you know, a whole list of diagnostic testing as patients come through, whatever it may be, it's imperative that we embrace it. Because otherwise, patient care is going to suffer.
Public health is going to suffer. And again, as I said before, our colleagues are pretty bright. So I'm hoping that as you and Dr. Morris continue to share what's going on in AI, I'm hoping that it's embraced by the professions.
So you mentioned, you started by framing it about independence. But there's also a huge category of retail optometry. And you know, this sort of, I mean, there's all private equity with an ophthalmology and optometry too. So I'm curious because you very carefully said independence.
I'm just wondering how you see the, does it apply to everyone or is there's what I'm doing? What I'm saying, yeah, what I'm saying about the growth of the industry and the AI and the demand, it applies to everyone. Got it. But my comment about independent really kind of relates to the fact that private equity is not going to take over the world.
The fact that corporate optometry is not going to take over the world, there's going to be a balance. And there's a fine tune equilibrium that works, whether it's a corporate retail setting and corporate retail probably has the greatest opportunity to utilize AI for medical diagnostic testing to not slow down the process. When I share with you the growth rate in the eye care industry, the eye care industry is about a $115 billion a year industry, $115 billion a year. Half of that is eyeglasses and contact lenses.
And then it's surgery, medical eye, and so and so, half of it is still on that optical side of things. And that it's shifting and I track that each and every year, medical eye care grows another one or 2% relative to optical, but regardless, both are growing. As an example, and again, the, when I speak of the growth in the industry, it applies to corporate optometry, corporate retail, private equity, just as a side note, because I track all this stuff, as I said, I'm a numbers geek, 15.6%, 15.6% of all optometrists and ophthalmologists are in a private equity consolidation. I never expected it to be on 20%, right?
That's about 15.6%, approximately. In any case, there are at least growth opportunities. So on the routine vision care side, I track up by routine vision and medical. I differentiate the two by diagnostic codes, ICD-10 codes.
So if it's a refractive diagnosis, myopia, I, grobias, stigmatism, presbyopiates, routine vision, anything that Medicare might pay for, I consider it to be medical eye care. In routine vision exams, if we look from some data that I have from 2021 to 2040, 20 21 to 2040, there's going to be an increase of approximately 21 million additional routine exams that need to be delivered each and every year. So we go from about 105 million routine vision exams delivered in the US in 2021 to 126 million that need to be delivered. It's a huge increase that the entire workforce will have to absorb both retail, corporate, private, private equity, independent, whatever you call it, 21 million additional routine vision exams.
But in medical, in that same time period, is going to increase by 36 million exams. 36 million exams. It's a huge increase. So if nothing changed in the way we deliver care today, if nothing at all changed, we'd have a public health crisis.
We would have decreased access to care. You'd call for an appointment. It would be a three month wait, whatever. There would not be access to care for both optometri and ophthalmology.
That's where you come in. That's where AI comes in. That's where we need to figure out how do we increase the throughput intelligently, properly with customer service in mind, with patient care in mind. How do we do it?
Because the numbers are staggering with what the growth is. Here's one of my favorite examples. In 2020, it's estimated in the US that 4.2 million, 4.2 million cataract procedures were performed in the US. 4.2 million 2020.
Ten years, fast forward, 2030, it's estimated that 5.6 million cataract procedures need to be performed based on demographics, growth of the aging population. It's an increase of 1.4 million cataract procedures that need to be delivered in a year. The average ophthalmologist, as you know, does about 400 a year. Now some do 3,000, some do 50, but on average it's 400 a year.
4,400 a year divided into 1.4 million additional cataracts means we need 3,500 additional ophthalmologists just for cataract surgery. Guess what? Health and Human Services said we had a shortage of ophthalmologists in 2025 of 6,180, and each year it's going to get worse by about 120 to 130 fewer ophthalmologists each and every year. But we need 3,500 more just for cataract surgery.
So cataract surgeons, general anterior segment ophthalmologists are going to spend more and more time in the surgical facilities in their ASCs, hopefully increase efficiency with AI and robotic, that sort. We hope that happens and has to happen. And by spending more and more time in the ASC, the clinic, the chronic care, someone needs to pick it up. Well that's where optometry needs to pick up the load and perform more of the chronic care and medical eye care in the clinic setting, ophthalmology more and more in the surgical setting.
But we've got a huge, huge workforce shortage and we need some solutions for it. And we need it in the next 5, 10 years, not 30 years out. I love the cataract example. There's a company that we featured called Horizon Surgical Systems that has a robotic cataract platform to that very point that you brought up of this impending tsunami of patients and we're just not prepared to do it.
And when I talk about it, very symposia or conferences or just sort of to my colleagues, and this is also true with an optometry with various devices and tools that are used as well as, particularly with refraction. There's a lot of fear. Is this robot device diagnostic refraction tool, fundus camera, whatever? Will it take my job or make me less valuable?
Right now you're painting a pretty optimistic picture, which is kind of like Kumbaya and happy and it sounds great. But when I do a talk, there's always someone usually toward the end of the question and answer session that kind of sheepishly raise their hand and be like, so is this going to take my job? Am I going to be out of a job? And so what do you, I guess there's two questions.
Specifically with these technologies, how do you see it? And maybe focus on refraction. That's kind of an interesting one to me. And two, what do you tell, what do you tell those often young eye care providers?
Yeah, I routinely present economics of the eye care industry to optometric programs, to third year students in optometry programs around the country. I do it gratis. I love sharing with them. And my message is there's never been a better time to complete an optometry optology program.
It's very positive. But you have to embrace the changes that are occurring. The last slide in my presentation to the students is Darwin. So with Darwin, we all think, I used to think it was survival of the fittest.
No, that was some other biologist. Darwin was those best able to adapt and adjust to a changing environment. And that's where we are today. A changing environment, AI is going to be a big component of that.
You know, you think of the whole field of, uh, Aquilomics of doing all the diagnostic testing. To me, it's what the doc is going to be doing is less hands on testing and more analysis. And decision making in partnership with AI treatment plans. So to me, the ideal world is a patient comes in, whether it's a, a, a retail corporate setting or the most advanced surgical collaborative optometry ophthalmology practice.
They come in and they get a whole battery of diagnostic tests that are analyzed by AI and presented to the doc with the patient to come up with some kind of treatment plan or to come up with, um, you know, what your risk factors are based on a variety of, uh, variables moving forward. There's plenty room for the docs. If we take a snapshot picture, I do this once a month, I update these numbers. How many job openings are there for optometrists?
Today, 2,400. How many finish a program each year? 1800. 2400 openings.
An ophthalmology 420. 420 openings for ophthalmologists. If any of our colleagues have tried to hire a new associate for the practice, whether it's optometr or ophthalmology, subspecialty, uh, you know, in retinue in the laucoma, whatever, maybe it is tough out there finding docs because we have a shortage. Well, the solution, obviously, one solution would be increasing the number of residency programs and ophthalmology, but the solution is technology.
The solution is how do we, um, create a more efficient, uh, work, uh, workflow, uh, within the, within the office and, and that's where I see, you know, from AI scribes on, that's where I see a lot of efficiency come word board and we really need to embrace it. We really need to, uh, uh, collaboratively optometri an ophthalmology need to work together, which I have a lot of work together. I'm jaded a little bit, but in any case, optometri an ophthalmology, uh, associations need to come together collaboratively agree that we've got this huge increase in demand for our services and come up, come up with some workable solutions to increase the throughput for the patients for the sake of public health in the U S. It's worse than other countries, but in the U S in particular, um, the, uh, the demand for, uh, the age related I care, it's, it's massive.
So what you, you tell this young doc, you tell them exactly that. Yes. I would. You're super bright.
You're never, you're never going to be lacking for a job for a professional job. You will always have a position. The typical, um, professional career for an optometrist or ophthalmologist is approximately 40 years average retirement ages for both professions average retirement ages 67. So for 40, you know, so if we look out 40 years and we think about, uh, Census Bureau projections in the U S, we look at workforce.
Uh, and, um, we look at AI and robotics and various efficiencies that are out there. Uh, really healthy 40 year professional career for both optometrature and ophthalmology. I wouldn't be concerned or worried about it whatsoever. We often say on our podcast, um, AI, those who use AI are going to replace those who insist on not using it.
So you have to use these efficiency technologies in order to, as you say, adapt and survive moving forward. Yeah. I absolutely agree with that. The, um, you know, there's a really interesting, uh, a podcast that Scott Mars did with Paul Carpeke, um, two or three weeks ago, maybe one of the best I've ever seen or heard.
Um, the two of them were going at it. And just Paul had such great insight into, you know, from something as simple as billing encoding assistance, uh, which is critical to, um, you know, genomics and, and figuring out risk factors, uh, uh, for patients based on their personal variables, but it was great. And it's those docs that embrace all that. They're going to be the most successful.
And I've, I've seen that. If we take a microcosm of, um, optometry, when I look at optometry with respect to the docs that do just routine vision versus medical, the growth in medical has been dramatic. Um, and when asked at, uh, they're, they're, uh, surveys done at a variety of meetings. And I see the greatest growth occurring in eye care and it's medical, uh, the responses, uh, far supersede any other response.
It's growth in medical eye care. And I've had a number of discussions with colleagues that in optometry particular, um, it's, it's going to kind of bifurcate to, um, docs that are just doing kind of old school routine refractive care and docs that are doing medical eye care. Similar to your analogy of docs that embrace AI and docs that don't embrace AI. Um, that's going to have an impact on the success of one's practice who'll be really interesting to see how that plays out.
Again, I encourage our professional associations, uh, to try to, uh, present where the opportunities are to help as many as possible. And again, not, it's really, we can look at this very altruistically. It's from a public health perspective. We've got, I look at the numbers that I track and we've got some serious challenges if we don't embrace change, if we don't adapt and adjust to this changing environment that we're in.
Yeah. Um, I talked to my fellow ophthalmologist. That's pretty common that, um, people who are mid career are just getting burnt out. And they don't actually reach the 65, 66 norm typical retirement age for eye care providers, because by the time they're dealing with, you know, reimbursement challenges every year of things being cut, you know, cataracts or just got another cut and you, it's sort of difficult.
I'm like, you know what? I'd rather just do something else. And so that, that, this is becoming a sort of a public health issue. And when I said it's your painting a good picture, well, you're painting a good picture for, you know, if you want a job, I mean, there's going to be, there'll be definitely patients, but for patients who are having to wait three, four months for surgery or just to get in for a routine eye, I visit.
I wonder, you know, what changes need to be, need to be made. Yeah, I wonder, as I've been thinking about anticipating you and I meeting today, I've been thinking about what are some of the things that can really help, um, act as a catalyst in this area. And, and maybe this is a collaborative effort of optometry, ophthalmology and industry and vendors in the industry, technology companies, of creating, if you will, AI labs, AI, you know, model practices where it's AI, it's, um, ophthalmic texts, optometrists, ophthalmologists, uh, robotics, the whole, again, the whole regimen of diagnostic testing and create, um, here's a model, you know, like the Alcons of the world set up in Fort Worth. Here's the model.
Come on through. We'll sponsor you to come through. This, this is what we need to do in the future. And I, I think that's going to be something like that is going to be critical because, um, it's going to be very difficult to learn it just on your own independently.
You guys do a great, you and Scott do a great job of getting the word out, but it's, uh, you know, taking the horse to water and think, or teach a man to fish kind of thing, um, whatever that analogy is. Yeah. Um, you know, we've talked about, we've talked about a lot, sort of what does the clinic of the future look like? Um, and so you're sort of giving us hints.
Talk a little bit about disruption in that clinic. Um, because I'm going to push back maybe a little bit and saying, you know, is it, is there going to be job displacement? And I think you've made a very good argument for eye care providers and, um, uh, I'll, uh, I'll trust your prediction. I hope you're right.
What about sort of, uh, technicians, front desk staff, because a lot of these AI solutions that we talk about have to do with administrative burdens, um, have to do with insurance authorizations, have to do with technician, um, support type tools. Because you know how hard it, I mean, you, you ran a very large practice getting the appropriate staff in the office. I mean, that's half the battle. Some days, that's the HR issues or a issue.
HR issues. And so tell me a little bit about efficiencies there, but also, you know, job disruptions or job changes, job title changes. What do you, how do you predict that sort of playing out? If anything, it's, um, it's going to be a, um, huge relief for anyone running a practice for any doc who has their own practice and the running practice because it will, um, I have anecdotal discussions all the time with talks that I can't find this employee, that employee, the, the challenges just, just as they're assured as your optometrist and ophthalmologist and the 2,400 openings for an optometry job.
Uh, you probably take optometry and ophthalmology, multiply it by 10 and that's how many openings for optomic text and front desk, diagnostic test, text scribes, so on and so forth. A big part of that solution is going to be some kind of automated system, which will be something along the lines of AI. And, um, there will be, you know, there about, what kind of about 20 years ago, there was a huge, uh, improvement in real time authorizations for patients. There are a number of companies that came up with, you know, a scanner insurance card.
And by the time they went from the kiosk that scanned it to the front desk, we were already are, we had the patient authorized. We already knew they were eligible. Well, that, the next step in that, I believe, will be, um, even before the patient walks into the office, um, all of that will be done by some type of AI. So the front desk staff, the burden on the front desk staff will maybe be decreased by 50%.
So your staffing can be decreased by 50%. People aren't going to lose jobs because of it, but it'll make it easier on the hiring front, um, less demand. And then for techs, um, they're similar. You know, as we know, we've gone from, uh, uh, uh, visual field testing to, you know, virtual field testing that doesn't require as much, uh, technician oversight, but still requires an atomic tech to do it well, do it right.
And, um, it'll just, it'll make the hiring process a lot easier. Just saw something recently, um, for, uh, uh, atomic tech training, some program, A-C-E-T kind of rings a bell, something just came out recently for an eight week online atomic tech training program. Very much needed. Absolutely needed.
Um, in today's world, 10 years from now, it might be less needed as we embrace more and more technology. But regardless, um, that human touch is still going to be valuable at the front desk through the exam process, through the halls of the clinic. Um, and, um, yeah, the scribes may be automated, voice recognition, a lot of, no, it's smoother, a lot better depending on the electronic medical record system being used. But, um, I think all of that is going to streamline the process and just made me think of something the, you know, I'm talking about all this age related.
I care over the next 10, 20, 30 years. Um, the birth rate in the U.S. has never been so low. So if, if we think of someone born today in 2026 and when they're 20 years old, being hired as a brand new, a atomic tech to train or a front desk receptionist or something like that, they're going to be fewer and fewer and fewer to choose from.
Yeah. It's going to worsen the situation. The birth rate in, I think it was in 2024, was the lowest it's ever been recorded in the U.S. as a percentage.
Huh. Last year was very well as well, uh, for a whole slew of reasons. But in any case, um, the labor supply for all that ancillary work is going to be challenged significantly. This is a solution for it, what we're talking about with AI.
It's definitely going to be a solution for it. The, um, uh, chart age, it just made me think of, I don't know if you, if any of those viewing this today, uh, watch the series, The Pit, uh, emergency medicine in the pit series. My brother who's an emergency medicine physician, uh, Professor of Emergency Medicine at Harvard said it's the, it's the first realistic emergency medicine show he's ever seen. But in any case, one of the, one of the docs was being given a lot of, uh, crap about, um, charting.
And it turns out there's this new AI program helping them chart and was having all these hallucinations. Just grow those bersards. So it was entertaining, but that's all going to get better. That's all going to get fixed.
That's all proof. So you bring up a really good point from the front desk to the text, to the diagnostic testing, to the docs in the rooms, to the retail optical staff. AI is going to help us survive and help patients get great care and maybe a hundred years from now, it's different. None of us are going to be around then, but for the next 40 years, for someone coming out today, into the profession, skies a limit.
It's a great time. I think it's a wonderful way to cap the conversation on, uh, on a clearly bullish and optimistic, uh, optimistic note. You know, I love it. Uh, Scott and I are very bullish about eye care moving forward.
And we read that there's not a, not a better time. Absolutely. It moves so fast, it's hard to predict though. It, it, it is a, a difficult, and you know, who knows?
Let's, let's chat again. Do let's do this. Let's chat again next year and see how things are going. Yes.
If you, I would love to. I really, I really enjoy this. And I want to thank you for putting us more and more on my radar of, of tracking some of the newer technologies, which I may have missed in some of my geeky numberness of stuff. But, um, it all needs to come together.
And again, Darwin, um, those who survive the best are those who are able to adapt and adjust to a changing environment. And if there's ever been a changing environment, that's here we are. And, uh, for our audience, you could definitely read more about that changing environment and how to adapt that, uh, for my shameless plug and AI and iCarra.com and listen to the podcast that Dr. Ed Lowe referenced with Dr.
Morris and Dr. Carpeke. Yes, sorry. Plastic, uh, and all our materials there.
Uh, Dr. Lowe, thank you so much for your time this morning. I think this has been one of the best sessions. I've learned a ton.
I'm sort of taking notes with all the geeky numbers. I loved it. Uh, and like I said, you're always a welcome guest. And we look forward to having you back on here soon.
Thank you. I really appreciate being a part of this. Thanks so much.