Almost 50 million Americans – disproportionately in rural areas – must drive 25 miles or more to access a gastroenterologist for diagnosis and treatment of issues involving the digestive system, according to a study from Weill Cornell Medicine researchers.
The findings, published Feb. 6 in Gastroenterology, have important implications for public health, considering gastroenterologists play a critical role in both preventive and therapeutic care. They screen for various conditions such as gastric and colorectal cancers, as well as treat disorders such as inflammatory bowel disease, acid reflux and liver disease.
The investigators used the Health Resources & Services Administration’s Area Health Resources data on U.S. physician workforce distribution and the 2020 U.S. Census to assess county-level access to gastroenterologists.
They determined that more than two-thirds of 3,149 counties in the United States had no gastroenterologist, leaving about 49 million people without a local option for care. Another 17% of counties had fewer than five gastroenterologists.
“While there is adequate access to gastroenterologists at the national level with most people living within 25 miles of a gastroenterologist, more attention is needed to increase access in underserved areas,” said co-first author Dr. Xiaohan Ying, M.D. ’22, a clinical associate in medicine at Weill Cornell Medicine and resident in internal medicine at NewYork-Presbyterian/Weill Cornell Medical Center. “Geographic disparities in access to physicians have widened, and unmet needs in gastroenterology care persist and are likely to worsen with an aging population.”
The analysis showed that about 80% of counties lacking a gastroenterologist were in non-metropolitan areas with higher populations of older adults, who are likely to have a greater need for this type of specialty care. These communities also had lower median incomes, fewer individuals with insurance and a higher proportion of white residents than counties with a gastroenterologist.
Alaska, North Dakota and Wyoming had the lowest proportions of gastroenterologists per 100,000 people, while Massachusetts, Connecticut and New York had the highest. These results suggest wide variations in geographic and economic barriers to access.
“Gastroenterologists in non-metropolitan counties were more likely to be older, with more than two-thirds of them older than age 55 and nearly half of those older than 65 years of age,” said co-first author Dr. Leah Yao, a clinical associate in medicine at Weill Cornell Medicine and resident in internal medicine at NewYork-Presbyterian/Weill Cornell Medical Center. “As these gastroenterologists retire, we will likely see worsening access in less populated areas exacerbating existing access disparities.”
Addressing this gap may mean advanced-practice clinicians could play an important role in helping to improve access to gastroenterological care, said the study’s co-senior author, Dr. Arun Jesudian, associate professor of clinical medicine and a transplant hepatologist at NewYork-Presbyterian/Weill Cornell Medical Center.
Jesudian said incentives to practice in underserved areas such as loan repayment or increased reimbursement may also help increase access to care.
“Policy interventions and other strategies to expand the gastroenterologist workforce and increase access in underserved areas are needed now,” he said.
Many physicians and scientists at Weill Cornell Medicine maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosures public to ensure transparency. For this information, please see profile for Dr. Arun Jesudian.
Bridget Kuehn is a freelance writer for Weill Cornell Medicine.
