177 - Orthopedic Surgeons in Rural Areas Are Aging and Not Increasing in Pac...

#177 Orthopedic Surgeons in Rural Areas Are Aging and Not Increasing in Pace with Total Physicians: A 15-year Longitudinal Workforce Analysis

Regulatory Issues: Coding, Reimbursement, Coverage

Poster Presented by: M. Fu


M. Fu (1)
R. Buerba (1)
J. Gruskay (1)
J.N. Grauer (1)

(1) Yale University School of Medicine, Department of Orthopedics and Rehabilitation, New Haven, CT, USA


Background: With the continued growth and aging of the population, demand for healthcare services and musculoskeletal care in particular is expected to increase substantially in the United States. It is unclear whether the current and future supply of orthopedic surgeons is sufficient to meet this need, especially in the context of increasing workplace demands and lifestyle expectations. Furthermore, there are well-documented concerns about disparities in health care provision between urban and rural populations. This study examines longitudinal trends and differences in the orthopedic workforce.

Methods: Demographic and physician distribution data for each year from 1995 to 2010 (except 1996, 2006, and 2009) for every county were obtained from the Area Resource File (ARF), a database published by the Department of Health and Human Services. Among the variables included in the ARF is the Rural-Urban Continuum Code (RUCC), a classification scheme that distinguishes “metropolitan” counties by size, and “nonmetropolitan” counties by the degree of urbanization and proximity to metropolitan areas.

County-level data for population, total physicians, orthopedic surgeons, orthopedic surgeons in various age brackets, and RUCC were aggregated up to a Hospital Referral Region (HRR) level. The HRR was our geographic unit of choice, given its widespread use as a measure of access to care centered around referral patterns for major surgical procedures.

Each of the 306 HRRs in the country were ranked based on RUCC. “Urban” areas were defined as the 30 most urban HRRs, and similarly for the most “rural” areas. The means of these 30 most urban and 30 most rural HRRs were calculated. HRR-level data were mapped to identify geographic areas of potential need.

Results: Total number of physicians increased 14.3% in urban areas from 1995 to 2010, from 294 to 336 per 100,000. This number also increased in rural areas from 1995 to 2010, by 11.9%, from 160 to 179 per 100,000.

The number of orthopedic surgeons decreased 4.4% in urban areas from 1995 to 2010, from 9.1 to 8.7 per 100,000. This number increased 4.8% in rural areas from 1995 to 2010, from 6.2 to 6.5 per 100,000.

The ratio of orthopedic surgeons over age 55 to those under age 55 increased 54.8% in urban areas from 1995 to 2010, from 0.42 to 0.65. This number also increased in rural areas from 1995 to 2010, by 73.6% from 0.53 to 0.92. Both areas demonstrated a significant increase in the age of orthopedic surgeons.

Conclusion: From 1995-2010, significant differences in the orthopedic workforce persisted between urban and rural areas of the United States. There were less orthopedic surgeons in rural areas per capita, and they tended to be older. These trends do not appear to be improving, and the age disparity is particularly worsening, which might predict areas of future rural shortages.