Distance to care and relative supply among pediatric surgical subspecialties

doi:10.1016/j.jpedsurg.2008.08.015

Journal of Pediatric Surgery

Volume 44, Issue 3, March 2009, Pages 483-495

https://doi.org/10.1016/j.jpedsurg.2008.08.015 Get rights and content

Abstract

Background/Purpose

The aim of this study is to describe geographic proximity to and quantify relative supply of 7 pediatric surgical specialties in the United States.

Methods

Data from the 2005 American Medical Association Physician Masterfile and the Claritas Pop-Facts Database were used to calculate subspecialty-specific, population-weighted, straight-line distances between each zip code centroid and the nearest provider. These same data sources were used to calculate the percentage of hospital referral regions with a provider, the percentage of the younger than 18 years population living within selected distances of providers, and provider-to-population ratios for each of the pediatric surgical subspecialties. Further, we calculated the correlation between practice locations and children's hospitals offering pediatric surgical services.

Results

Across pediatric surgical specialties, average distances to the nearest provider ranged from 27.1 miles for pediatric surgery to 100.9 miles for pediatric cardiothoracic surgery. The average population-weighted distance to a provider was less than 30 miles for pediatric surgery and pediatric ophthalmology only. For 5 of the 7 pediatric surgical specialties studied, approximately one quarter of the younger than 18 years population lives more than 1-hour drive from a provider. Provider–to–younger than 18 years population ratios range across hospital referral region from 0.04 per 100,000 for pediatric cardiothoracic surgery to 0.97 per 100,000 for pediatric surgery. The correlation between pediatric surgeons and children's hospitals offering services was 0.72.

Conclusions

Although the practice locations of pediatric surgical subspecialties parallel the geographic distribution of children in the United States, large percentages of the younger than 18 years population must travel long distance to receive care from these providers. Large coefficients of variation reveal substantial maldistribution. These findings lay the groundwork for workforce assessments of the pediatric surgical subspecialties and underscore the need for future studies that assess access barriers for children in need of surgical care.

Section snippets

Background/purpose

Pediatric surgical subspecialization has been associated with lower complication rates among children with perforated appendixes [1], decreased risk of mucosal perforation post pyloromyotomy, and greater precision in tumor removal [2]. When compared to children treated by general surgeons, studies have demonstrated lower costs and/or shorter lengths of stay among younger children treated by pediatric surgical specialists for appendectomy [3], uncomplicated pyloromyotomy [3],

Data sources

We use physician data from 2005 AMA Physician Masterfile. The Masterfile contains current and historical data on more than 800,000 physicians, including both AMA members and nonmembers, residing in the United States who have completed the educational requirements necessary to be recognized as physicians in the United States (http://www.ama-assn.org/ama/pub/category/2673.html). In addition, we used data from the National Association of Children's Hospitals and Related Institutions (//www.childrenshospitals.net

Results

Maps depicting the provider locations for each of the pediatric surgical specialties of interest are presented in Fig. 1, Fig. 2, Fig. 3, Fig. 4, Fig. 5, Fig. 6, Fig. 7, Fig. 8.

Pediatric surgery and pediatric ophthalmology are the most geographically accessible of the 7 pediatric surgical specialties studied. On average, a child in the United States must travel 27.1 miles to the nearest pediatric surgeon and 28.5 miles to the nearest pediatric ophthalmologist (Table 1). Average distances to the

Discussion

Geographic access is one of many determinants of overall access to care. This study demonstrates that average distances to pediatric surgical care are greater than for the general surgery and surgical specialties. Naturally, we expect greater distances to care for pediatric surgical specialists given the generally low prevalence of conditions treated by many of these providers. Low prevalence rates limit the demand for and the financial viability of their pediatric surgical subspecialty

Conclusion

This is the first study to estimate distances to care and relative supply of pediatric surgical specialists in the United States. The study also provides useful comparison data on general surgery and surgical specialties. The findings suggest that a substantial percentage of the pediatric population in the United States must travel one or more hours to reach a pediatric surgical specialist, whereas access to general surgical providers is much more extensive. Furthermore, our findings suggest

Acknowledgments

We would like to thank Bob Schwartz and Ann Howard for performing the distance analyses; Tom Ricketts, PhD, for providing access to the AMA Masterfile and commenting on previous drafts; and George F. Sheldon, MD, for his helpful insights.

The research was supported through grant number 1-K02-HS013309-01A1 from the Agency for Healthcare Research and Quality and a University Research Council grant from the University of North Carolina at Chapel Hill. The funding agency was not involved in the

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Original articleDistance to care and relative supply among pediatric surgical subspecialties

Abstract

Background/Purpose

Methods

Results

Conclusions

Section snippets

Background/purpose

Data sources

Results

Discussion

Conclusion

Acknowledgments

J Pediatr Surg

J Pediatr Surg

Ann Thorac Surg

J Urol

Journal of Pediatric Surgery

Otolaryngol Head Neck Surg

Correlation of neurosurgical subspecialization with outcomes in children with malignant brain tumors

Neurosurgery

Effect of pediatric surgical practice on the treatment of children with appendicitis

Pediatrics

Does surgical subspecialization in pediatrics provide high-quality, cost-effective patient care?

Pediatrics

A longitudinal analysis of the pediatric surgeon workforce

Ann Surg

Update on the analysis of the need for pediatric surgeons in the United States

J Pediatr Surg

Projected societal needs in pediatric otolaryngology

Laryngoscope

Workforce issues for the academic otolaryngologist

Laryngoscope

Practice of pediatric otolaryngology: results of the future of pediatric education II project

Arch Otolaryngol Head Neck Surg

Workforce demand for neurosurgeons in the United States of America: a 13-year retrospective study

J Neurosurg

Pediatric urology manpower report 1995. Ellen Shapiro on behalf of the American Association of Pediatric Urologists

J Urol

Original article
Distance to care and relative supply among pediatric surgical subspecialties