Plastic surgery access deserts in the United States: A GIS-based national assessment

Timely access to plastic and reconstructive surgery is critical for trauma, burns, congenital anomalies, hand conditions, and oncologic reconstruction. Prior workforce studies often rely on county- or state-level surgeon counts, which fail to capture patient travel burden. Network-based geographic analyzes using travel time may better reflect true access.

Using the 2023 Centers for Medicare & Medicaid Services Physician and Other Practitioners Public Use File, all Medicare-participating plastic surgeons with valid U.S. practice addresses were identified. Locations were geocoded and used to generate one-hour drive-time service areas (OHSAs) in ArcGIS Pro. Census Block Group population data were spatially intersected with OHSAs to estimate the proportion of residents living within and beyond a one-hour drive. State-level percentages outside any OHSA were calculated and ranked.

A total of 3122 plastic surgeons were included. Nationally, 24,120,867 individuals (7.27% of the U.S. population) lived outside a one-hour plastic surgery service area. Marked state-level variation was observed, with the highest proportions outside any OHSA in Wyoming (63.0%), Alaska (44.7%), and South Dakota (40.8%). The lowest proportions were seen in Rhode Island (0.4%), New Jersey (0.4%), and Connecticut (0.5%).

While national coverage appears favorable, substantial geographic access gaps to plastic surgery persist, particularly in rural and sparsely populated states. Drive-time-based analysis provides a more realistic measure of access and may inform workforce planning and policy efforts to reduce disparities in reconstructive surgical care.