Why the Divide? A Demographic Comparison of Eye Care Providers in Rural and Urban Counties.

PURPOSE: To characterize the geographic distribution of eye care providers across rural and urban United States (U.S.) counties and compare provider demographics, reimbursement, and patient populations between rurality strata. METHODS: The 2022 Medicare Physician & Other Practitioners database was used to identify all participating ophthalmologists and optometrists. Demographic and Medicare reimbursement data were then merged with the National Downloadable File for gender and graduation year. Provider addresses were geocoded and mapped to U.S. counties using ArcGIS Pro. Counties were classified as rural (≥90% rural population), mostly rural (≥50%), or mostly urban (<50%) based on 2020 Census data. Provider characteristics, service volume, and reimbursement was compared across rurality categories. RESULTS: Ophthalmologist density was highest in mostly urban counties (4.12 per 100,000) and lowest in rural counties (0.09; p < 0.001). Optometrist density was more evenly distributed but still greater in mostly urban areas (11.76 vs. 5.13; p < 0.001). Rural ophthalmologists were older (median graduation 1994 vs. 1999; p = 0.031) and more often male (73.3% vs. 72.2%; p < 0.001). They served more Medicare beneficiaries but received less reimbursement than ophthalmologists in mostly urban counties ($276,305.77 vs. $419,480.36; p = 0.030). Rural optometrists were also older, more likely male, and served more beneficiaries, but received higher payments than their mostly urban counterparts ($37,514.23 vs. $28,546.26; p < 0.001). CONCLUSIONS: Eye care providers remain underrepresented in rural U.S. counties, with an aging rural workforce and lower Medicare reimbursement further threatening the long-term viability of rural eye care services. Targeted intervention strategies are required to address existing inequities in access to care.