The division of labour in vision care: professional competence in a system of professions

The provision of vision care services by ophthalmologists, general practitioners, orthoptists, optometrists and opticians in the Netherlands was investigated. We assessed their division of labour, task boundary conflicts, and consensus on professional domains. Analysis of six patient cases indicated considerable overlap in the services provided by these professions. Only general practitioners and orthoptists were content with their current role. Ophthalmologists preferred to delegate cases, optometrists and opticians to expand their services. The results revealed important differences in inter-professional status, more or less fixed-status hierarchies and dissatisfaction with the existing division of labour. Preferences of the professions did not point to increased inter-professional co-ordination; this could probably only be achieved by means of external intervention.