title: Strabismus surgical subspecialization: a population-based analysis.
abstract: OBJECTIVE
  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 health care human resources planning and educational programs.
  
  
  OBJECTIVE
  To investigate the effect of subspecialization on the provision of strabismus surgery services.
  
  
  METHODS
  Population-based study in Ontario, Canada, which provides universal health care 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.
  
  
  METHODS
  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
  Strabismus surgery has evolved into a subspecialized field of ophthalmology during the past 15 years. These findings may have important implications for health care professionals and health care 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.
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada2Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ontario, Canada3Department of Ophthalmology, Kingston General Hospital, Kingston, Ontario, Canada4Institute for Clinical.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Campbell
authors.affiliation: Institute for Clinical Evaluative Sciences, Queen's University site, Kingston, Ontario, Canada5Division of Geriatric Medicine, Queen's University, Kingston, Ontario, Canada6Division of Geriatric Medicine, St Mary's of the Lake Hospital, Kingston, Ontario.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada2Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ontario, Canada3Department of Ophthalmology, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Ten Hove
authors.affiliation: Department of Ophthalmology, University of Toronto, Toronto, Ontario, Canada8Department of Ophthalmology, Kensington Eye Institute, Toronto, Ontario, Canada.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: El-Defrawy
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada2Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ontario, Canada3Department of Ophthalmology, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Yi Ning J
authors.initials: YN
authors.lastname: Strube
authors.affiliation: Institute for Clinical Evaluative Sciences, Queen's University site, Kingston, Ontario, Canada.
authors.forename: Marlo
authors.initials: M
authors.lastname: Whitehead
authors.affiliation: Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada2Department of Ophthalmology, Hotel Dieu Hospital, Kingston, Ontario, Canada3Department of Ophthalmology, Kingston General Hospital, Kingston, Ontario, Canada.
authors.forename: Erica de L P
authors.initials: Ede L
authors.lastname: Campbell
authors.affiliation: Evaluative Clinical Sciences, Sunnybrook Health Sciences Centre site, Toronto, Ontario, Canada10Department of Medicine, University of Toronto, Toronto, Ontario, Canada11Department of Health Policy Management and Evaluation, University of Toronto, Toronto.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006302:Health Services Research; D006801:Humans; D009801:Oculomotor Muscles / Q000601:surgery*; D009864:Ontario / Q000453:epidemiology; D013508:Ophthalmologic Surgical Procedures / Q000706:statistics & numerical data*; D009885:Ophthalmology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D013285:Strabismus / Q000601:surgery*; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D000078329:Workforce