Supply and Distribution of Vascular Access Physicians in the United States: A Cross-Sectional Study

Background: As functioning permanent vascular access (arteriovenous fistulas [AVF] or arteriovenous grafts [AVG]) is crucial for optimizing patient outcomes on hemodialysis, the supply of physicians placing vascular access is key. We investigated whether area-level demographic and healthcare market attributes were associated with the distribution and supply of AVF/AVG access physicians in the U.S. Methods: A nationwide registry of physicians placing AVF/AVG in 2015 was created using data from the US Renal Data System and the American Physician Association9s Physician Masterfile. We linked the registry information to the Area Health Resource File to assess the supply of AVF/AVG access physicians and their professional attributes by Hospital Referral Region (HRR). Bivariate analysis and Poisson regression were performed to examine the relationship between AVF/AVG access physician supply and demographic, socioeconomic, and health resources conditions of HRRs. Setting: All 50 states. The main outcome was supply of AVF/AVG access physicians, defined as the number of physicians performing AVF and/or AVG placement per 1,000 prevalent end stage kidney disease patients. Results: The majority of vascular access physicians were aged 45-64 (average age=51.6), male (90.8%), trained in the U.S. (76.4%), and registered in a surgical specialty (73.6%). The supply of physicians varied substantially across HRRs. The supply was higher in HRRs with higher % White population (s=0.44; SE=0.14; p=0.002), lower unemployment rates (s=-10/74; SE=3.41; p=0.002), and greater supply of primary care physicians (s=0.18; SE=0.05; p=0.001) and nephrologists (s=15.89; SE=1.22; p