Geospatial Analysis of Rural-Urban Access of Otolaryngology-Head and Neck Surgeons and Clinics in Vermont

This study examines the distribution of Otolaryngology-Head and Neck Surgeons (OHNS) in Vermont to identify gaps in OHNS clinic accessibility between rural and urban areas and better understand the disparities faced by Vermonters.

A geospatial, population-based cross-sectional study was conducted, and the OHNS workforce was assessed using public databases. The ArcGIS Pro Near Analysis tool was used to assess the travel burden to OHNS clinics. Wilcoxon rank sum tests were used to compare the average distances to Comprehensive Otolaryngology Care Centers (COCC) and General Otolaryngology Clinics (GOC) between rural and urban towns.

Vermonters have access to 15 OHNS clinics in Vermont, with 10 additional clinics in counties of bordering states. Nearly 43% of counties in Vermont lacked any OHNS clinic. While urban areas of Vermont had the fewest OHNS clinics, they had the largest number of practicing otolaryngologists. On average, Vermonters in urban towns were 31.0 km from a COCC, while those in rural towns were 68.7 km away (p < 0.001). Conversely, on average, Vermonters in urban towns were 25.9 km from a GOC, compared to 22.0 km for those in rural towns (p < 0.001).

Rural residents in Vermont must travel farther distances to obtain OHNS services. However, rural Vermonters face significantly less travel burden to GOCs than urban residents, suggesting that GOCs are well-positioned to reduce disparities in travel burden to OHNS for rural populations. GOCs tend to provide less comprehensive care than COCCs and may, therefore, incompletely improve the distribution and availability of comprehensive otolaryngology services in rural areas.