Joshua Herb1,2, Mark Holmes2, Karyn Stitzenberg1. 1. Division of Surgical Oncology, Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 2. Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Abstract
PURPOSE: We evaluated temporal trends in rural-urban disparities of the surgeon supply among surgeons commonly treating patients with cancer. METHODS: We performed a retrospective observational study of county-level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural-Urban Commuting Codes (RUCC), and evaluated percent changes in the rural-urban disparity in physician density. Secondary analyses evaluated these changes by Census region. Additionally, Gini indices were calculated by year and RUCC to evaluate the workforce inequality within rural areas. FINDINGS: Total surgical specialist density declined in rural areas from 16 to 14 per 100,000 population, and declined slightly from 33 to 31 per 100,000 population in urban areas, for a rural-urban disparity increase of 8% (95% CI 5%,10%). Among specific specialties, the percentage increase in the rural-urban workforce supply disparity was largest for colorectal surgeons and general surgeons at 66% (95% CI 51%,80%) and 72% (95% CI 58%,86%), respectively, although absolute changes were small. Regional heterogeneity of the workforce was higher for rural areas than urban areas. CONCLUSIONS: Changes in the rural-urban physician workforce disparities over time are dependent upon specialty, region, and local community factors. This highlights how surgical workforce policy should be oriented to the local area circumstances.
PURPOSE: We evaluated temporal trends in rural-urban disparities of the surgeon supply among surgeons commonly treating patients with cancer. METHODS: We performed a retrospective observational study of county-level workforce changes from 2004 to 2017 using the Area Health Resource File. We calculated physician density (providers/100,000 population) for each specialty by rural and urban counties using the 2003 Rural-Urban Commuting Codes (RUCC), and evaluated percent changes in the rural-urban disparity in physician density. Secondary analyses evaluated these changes by Census region. Additionally, Gini indices were calculated by year and RUCC to evaluate the workforce inequality within rural areas. FINDINGS: Total surgical specialist density declined in rural areas from 16 to 14 per 100,000 population, and declined slightly from 33 to 31 per 100,000 population in urban areas, for a rural-urban disparity increase of 8% (95% CI 5%,10%). Among specific specialties, the percentage increase in the rural-urban workforce supply disparity was largest for colorectal surgeons and general surgeons at 66% (95% CI 51%,80%) and 72% (95% CI 58%,86%), respectively, although absolute changes were small. Regional heterogeneity of the workforce was higher for rural areas than urban areas. CONCLUSIONS: Changes in the rural-urban physician workforce disparities over time are dependent upon specialty, region, and local community factors. This highlights how surgical workforce policy should be oriented to the local area circumstances.
Authors: Ateev Mehrotra; Haiden A Huskamp; Alok Nimgaonkar; Krisda H Chaiyachati; Eric Bressman; Barak Richman Journal: JAMA Health Forum Date: 2022-09-02