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The Geographic Distribution of Pediatric Anesthesiologists Relative to the US Pediatric Population
Matthew K Muffly1, David Medeiros, Tyler M Muffly
1From the *Stanford University Medical Center, Stanford, California; †Stanford University Geospatial Center, Stanford, California; and ‡Denver Health Medical Center, Denver, Colorado.
Insights
Millions of US children lack proximity to pediatric anesthesiologists, impacting access to specialized care. Geographic disparities highlight the need for improved distribution of these essential medical professionals.
Area of Science:
- Anesthesiology
- Pediatrics
- Health Services Research
- Geographic Information Systems (GIS)
Background:
- Geographic distribution of pediatric anesthesiologists is crucial for clinical care and policy.
- Understanding this distribution relative to the pediatric population is essential.
Purpose of the Study:
- To map and analyze the geographic distribution of pediatric anesthesiologists in the US.
- To assess the proximity of the pediatric population (0-17 years and 0-4 years) to these specialists.
Main Methods:
- Utilized GIS to create driving distance service areas around pediatric anesthesiologist locations.
- Employed US Census block groups to calculate pediatric population density within these areas.
- Determined pediatric anesthesiologist-to-pediatric population ratios across 306 Hospital Referral Regions (HRRs).
Main Results:
- 71.4% of children live within a 25-mile drive of a pediatric anesthesiologist.
- Over 10.2 million children (0-17 years) and 2.7 million young children (0-4 years) reside more than 50 miles away.
- Pediatric anesthesiologist distribution is less uniform and lower compared to other physician groups.
Conclusions:
- A significant portion of the US pediatric population faces geographic barriers to accessing pediatric anesthesiologists.
- Wide variations in HRR-level ratios suggest unequal access to care.
- Findings are critical given new guidelines mandating pediatric anesthesiologist involvement in pediatric surgery verification.
Background:
The geographic relationship between pediatric anesthesiologists and the pediatric population has potentially important clinical and policy implications. In the current study, we describe the geographic distribution of pediatric anesthesiologists relative to the US pediatric population (0-17 years) and a subset of the pediatric population (0-4 years).
Methods:
The percentage of the US pediatric population that lives within different driving distances to the nearest pediatric anesthesiologist (0 to 25 miles, >25 to 50 miles, >50 to 100 miles, >100 to 250 miles, and >250 miles) was determined by creating concentric driving distance service areas surrounding pediatric anesthesiologist practice locations. US Census block groups were used to determine the sum pediatric population in each anesthesiologist driving distance service area. The pediatric anesthesiologist-to-pediatric population ratio was then determined for each of the 306 hospital referral regions (HRRs) in the United States and compared with ratios of other physician groups to the pediatric population. All geographic mapping and analysis was performed using ArcGIS Desktop 10.2.2 mapping software (Redlands, CA).
Results:
A majority of the pediatric population (71.4%) lives within a 25-mile drive of a pediatric anesthesiologist; however, 10.2 million US children (0-17 years) live greater than 50 miles from the nearest pediatric anesthesiologist. More than 2.7 million children ages 0 to 4 years live greater than 50 miles from the nearest identified pediatric anesthesiologist. The median ratio of pediatric anesthesiologists to 100,000 pediatric population at the HRR level was 2.25 (interquartile range, 0-5.46). Pediatric anesthesiologist geographic distribution relative to the pediatric population by HRR is lower and less uniform than for all anesthesiologists, neonatologists, and pediatricians.
Conclusions:
A substantial proportion of the US pediatric population lives greater than 50 miles from the nearest pediatric anesthesiologist, and pediatric anesthesiologist-to-pediatric population ratios by HRR vary widely across the United States. These findings are important given that the new guidelines from the American College of Surgeons Children's Surgery Verification™ Quality Improvement Program state that pediatric anesthesiologists must care for a subset of pediatric patients. Because of the geographic distribution of pediatric anesthesiologists relative to the pediatric population, access to care by a pediatric anesthesiologist may not be feasible for all children, particularly for those with limited resources or in emergent situations.
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