title: Effect of cataract surgery volume constraints on recently graduated ophthalmologists: a population-based cohort study.
abstract: BACKGROUND
  Across Canada, graduates from several medical and surgical specialties have recently had difficulty securing practice opportunities, especially in specialties dependent on limited resources such as ophthalmology. We aimed to investigate whether resource constraints in the health care system have a greater impact on the volume of cataract surgery performed by recent graduates than on established physicians.
  
  
  METHODS
  We used population-based administrative data from Ontario for the period Jan. 1, 1994, to June 30, 2013, to compare health services provided by recent graduates and established ophthalmologists. The primary outcome was volume of cataract surgery, a resource-intensive service for which volume is controlled by the province.
  
  
  RESULTS
  When cataract surgery volume in Ontario entered a period of government-mandated zero growth in 2007, the mean number of cataract operations performed by recent graduates dropped significantly (-46.37 operations/quarter, 95% confidence interval [CI] -62.73 to -30.00 operations/quarter), whereas the mean rate for established ophthalmologists remained stable (+5.89 operations/quarter, 95% CI 95% CI -1.47 to +13.24 operations/quarter). Decreases in service provision among recent graduates did not occur for services without volume control. The proportion of recent graduates providing exclusively cataract surgery increased over the study period, and recent graduates in this group were 5.24 times (95% CI 2.15 to 12.76 times) more likely to fall within the lowest quartile for cataract surgical volume during the period of zero growth in provincial cataract volume (2007-2013) than in the preceding period (1996-2006).
  
  
  CONCLUSIONS
  Recent ophthalmology graduates performed many fewer cataract surgery procedures after volume controls were implemented in Ontario. Integrated initiatives involving multiple stakeholders are needed to address the issues facing recently graduated physicians in Canada.
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont. rob.campbell@queensu.ca.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Campbell
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Sherif R
authors.initials: SR
authors.lastname: El-Defrawy
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Sudeep S
authors.initials: SS
authors.lastname: Gill
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Philip L
authors.initials: PL
authors.lastname: Hooper
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Marlo
authors.initials: M
authors.lastname: Whitehead
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Erica de L P
authors.initials: EL
authors.lastname: Campbell
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Robert
authors.initials: R
authors.lastname: Nesdole
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Daniel
authors.initials: D
authors.lastname: Warder
authors.affiliation: Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Division of Geriatric Medicine (Gill) and Department of Public Health Sciences (Whitehead), Queen's University, Kingston, Ont.; Department of Ophthalmology (R. Campbell, E. Campbell, Nesdole, Warder, ten Hove), Hotel Dieu Hospital, Kingston, Ont.; Institute for Clinical Evaluative Sciences (R. Campbell, Gill, Whitehead), Kingston, Ont.; Department of Ophthalmology (El-Defrawy), Department of Medicine (Bell) and Institute of Health Policy, Management and Evaluation (Bell), University of Toronto, Toronto, Ont.; Department of Ophthalmology (El-Defrawy), Kensington Eye Institute, Toronto, Ont.; Institute for Clinical Evaluative Sciences (Bell), Toronto, Ont.; Division of Geriatric Medicine (Gill), St. Mary's of the Lake Hospital, Kingston, Ont.; Department of Ophthalmology (Hooper), University of Western Ontario, London, Ont.; Department of Ophthalmology (Hooper), St. Joseph's Hospital, London, Ont.; Department of Ophthalmology (E. Campbell, Nesdole, Warder, ten Hove) Kingston General Hospital, Kingston, Ont.
authors.forename: Martin
authors.initials: M
authors.lastname: Ten Hove
mesh_terms: D002387:Cataract Extraction / Q000706:statistics & numerical data* / Q000639:trends*; D016208:Databases, Factual; D015276:Health Care Rationing / Q000639:trends*; D006295:Health Resources / Q000639:trends*; D006301:Health Services Needs and Demand / Q000639:trends*; D006801:Humans; D016015:Logistic Models; D009864:Ontario; D000072163:Ophthalmologists; D012189:Retrospective Studies; D013043:Specialties, Surgical