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J Pediatr Surg. 2009 Mar;44(3):483-95. doi: 10.1016/j.jpedsurg.2008.08.015.

Distance to care and relative supply among pediatric surgical subspecialties.

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  • 1Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.



The aim of this study is to describe geographic proximity to and quantify relative supply of 7 pediatric surgical specialties in the United States.


Data from the 2005 American Medical Association Physician Masterfile and the Claritas Pop-Facts Database were used to calculate subspecialty-specific, population-weighted, straight-line distances between each zip code centroid and the nearest provider. These same data sources were used to calculate the percentage of hospital referral regions with a provider, the percentage of the younger than 18 years population living within selected distances of providers, and provider-to-population ratios for each of the pediatric surgical subspecialties. Further, we calculated the correlation between practice locations and children's hospitals offering pediatric surgical services.


Across pediatric surgical specialties, average distances to the nearest provider ranged from 27.1 miles for pediatric surgery to 100.9 miles for pediatric cardiothoracic surgery. The average population-weighted distance to a provider was less than 30 miles for pediatric surgery and pediatric ophthalmology only. For 5 of the 7 pediatric surgical specialties studied, approximately one quarter of the younger than 18 years population lives more than 1-hour drive from a provider. Provider-to-younger than 18 years population ratios range across hospital referral region from 0.04 per 100,000 for pediatric cardiothoracic surgery to 0.97 per 100,000 for pediatric surgery. The correlation between pediatric surgeons and children's hospitals offering services was 0.72.


Although the practice locations of pediatric surgical subspecialties parallel the geographic distribution of children in the United States, large percentages of the younger than 18 years population must travel long distance to receive care from these providers. Large coefficients of variation reveal substantial maldistribution. These findings lay the groundwork for workforce assessments of the pediatric surgical subspecialties and underscore the need for future studies that assess access barriers for children in need of surgical care.

[PubMed - indexed for MEDLINE]
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