Trends in rural‐urban disparities among surgical specialties treating cancer, 2004‐2017

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.

Receipt of Out-of-State Telemedicine Visits Among Medicare Beneficiaries During the COVID-19 Pandemic

“…A second population more likely to capitalize on a relaxation of state telemedicine restrictions are rural beneficiaries and those who live in counties with fewer physicians per capita. We believe these differences are partly driven by the lack of availability of specialty clinicians in the local community in rural areas and specifically the lack of availability of tertiary care centers . This likely explains why we saw greater use of out-of-state telemedicine for conditions such as cancer and conditions treated by uncommon specialists.…”

“…We believe these differences are partly driven by the lack of availability of specialty clinicians in the local community in rural areas and specifically the lack of availability of tertiary care centers. 22 , 23 , 24 This likely explains why we saw greater use of out-of-state telemedicine for conditions such as cancer and conditions treated by uncommon specialists. As state licensure regulations change, it will be important to track telemedicine use among these populations to assess if use differentially falls.…”

Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: A randomized cross‐over study

“…For example, the prevalence of cigarette smoking in rural Appalachian Ohio was 27% among men and 26% among women in 2019; in non-Appalachian metro areas of Ohio the prevalence of cigarette smoking was 23% among men and 21% among women [41]. These disparities in cigarette smoking, in combination with other factors including higher poverty rates and reduced access to specialized health care [42,43], contribute to cancer disparities for people living in rural and Appalachian regions of the United States [29][30][31][32]. With the stubbornly high prevalence of tobacco use in these regions, approaches that involve switching from a higher-risk to a lower-risk tobacco product, such as ONPs [11],…”

Availability of hospital‐based cancer services before and after rural hospital closure, 2008‐2017

“…The loss of surgeons and surgical service lines may be a precursor to hospital closure. Studies show that surgeon supply has decreased in rural counties with rural‐urban disparities being most pronounced among general surgeons 23 . Another study found that annual reductions in the supply of general surgeons and surgical specialists led to rural hospital closures 24 .…”

“…Studies show that surgeon supply has decreased in rural counties with rural-urban disparities being most pronounced among general surgeons. 23 Another study found that annual reductions in the supply of general surgeons and surgical specialists led to rural hospital closures. 24 The loss of these providers, and the subsequent loss of revenue from surgical procedures, may be a factor in rural hospital clo-sures in addition to the lack of Medicaid expansion that may protect against uncompensated care and improve revenue and margins.…”