Introduction: The 2018 American Urological Association Census reported that 60% of counties in the United States do not have a practicing urologist. We evaluated the impact of this disparity on metrics of access to complex urological surgery.
Methods: We used the 2012-2016 20% Medicare file and US Census data for this analysis. We first calculated the linear distance between patient and nearest urologist for patients that reside in metropolitan, micropolitan, and rural areas. Next, we determined the distance between patients in these three areas and the nearest urologist that performs complex urological surgery—defined as radical cystectomy, percutaneous nephrolithotomy and partial nephrectomy.Then for each area, we calculated the number of urologists per 100K patients that perform complex urological surgery. Finally, we assessed travel patterns for rural patients who need complex urological surgery.
Results: Approximately 90,000 Medicare beneficiaries sought care from 9,300 urologists in each year of our study. 7,200 of these patients (8%) and 744 of these urologists (5%) were located in rural areas. In 2016, rural patients were 34 miles (median, IQR 17-58 miles) from the nearest urologist compared to 10 miles (median, IQR 5-22 miles) for patients in metropolitan areas (p <0.001). For complex urological surgery, rural patients were 39 miles away (median, IQR 22-63 miles) while patients in metropolitan areas were 10 miles away (IQR 5-21; p<0.001). There were 4.5 urologists who perform complex procedures/100K patients in both rural and metropolitan areas. 70% of rural patients requiring complex urologic procedures travel to metropolitan areas.
Conclusions: Rural patients travel a fourfold longer distance for complex urological surgery than their metropolitan counterparts. These findings guide future work on how geographical distance can lead to delays in diagnosis/treatment, enrollment in clinical trials and provision of follow up care after surgery for rural patients. Source of