THE RELATIVE GEOGRAPHIC AVAILABILITY OF PEDIATRIC AND ADULT SUBSPECIALISTS
Chiang-hua Chang, William L. Cull, David C. Goodman.. Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH; Division of Health Services Research, American Academy of Pediatrics, Elk Grove Village, IL; Hanover, NH.

BACKGROUND: The adequacy of the supply of pediatric subspecialists remains in doubt, despite increased numbers during the last decade.

OBJECTIVE: To describe the geographic availability of 8 pediatric and adult subspecialists using travel time measures.

DESIGN/METHODS: Data sources: 2000 U.S. Census data for the location of populations < 18 years; 2001 AMA Masterfile and web sources for the location of self-designated subspecialists. We estimated road-based travel times from each ZIP area to the nearest subspecialist using ArcView Network Analyst. Estimations incorporated speed limits, type of roads, and rural/urban characteristics using GDT 2000 road data.

RESULTS: The majority of children (N=72,286,720) lived within 60 min to cardiology (82.9% of pediatric population), hematology/oncology (77.2%), pediatric surgery (76.8%), endocrinology (74.4%), pulmonary (73.3%), nephrology (69.7%), gastroenterology (73.0%), and rheumatology (57.9%) subspecialists. In rural areas, the proportion of children (N= 12,291,722) living more than 2 hours was 17.7% for cardiology, 24.0% pediatric hematology/oncology, 25.9% pediatric surgery, 25.1% endocrinology, 30.6% pulmonary, 36.0% nephrology, 30.4% gastroenterology, and 51.6% rheumatology. White, non-Hispanic children had longer travel to subspecialists in urban, but shorter travel in rural areas compared to other racial/ethnic groups. ZIP area poverty was not associated with travel time differences. When adult specialists were included, travel time to subspecialists decreased by at least 2-fold (mean 46.2 min reduced to 20.8 min to see an endocrinologist) to more than 6-fold (mean 42.8 min reduced to 6.5 min to see a pediatric/general surgeon). Including adult specialists reduced the proportion of the rural pediatric population more than 2 hours from subspecialists to less than 10%.

CONCLUSIONS: A large number of children, primarily those residing in rural areas, have excessively long distances to pediatric subspecialists and may face additional barriers to access. The incorporation of adult specialists in rural pediatric care networks could reduce the travels dramatically, although the quality of this care remains poorly understood.