Disparities in the Geographic Distribution of Neurosurgeons in the US: A Geospatial Analysis.

OBJECTIVE Large disparities in access to neurosurgical care are known, but there is limited data on whether geographical distribution of the neurosurgery workforce potentially play a role in these disparities. The goal of this study was to identify the geographic distribution of neurosurgeons in the United States and to study the association of the per-capita workforce distribution with socioeconomic characteristics of the population. METHODS The number of practicing neurosurgeons in the United States in 2016 was obtained from the 2017-2018 American Medical Association (AMA) Masterfile contained within the Area Health Resource File. The association of the number of neurosurgeons per 100,000 population with socioeconomic characteristics was assessed through linear regression analysis at Hospital Referral Region (HRR) level. RESULTS The median number of neurosurgeons per capita across all HRRs was 1.47 neurosurgeons per 100,000 population (IQR 1.02-2.27). Bivariable analysis revealed that greater supply of neurosurgeons was positively associated with regional levels of college education, median income, and median age. The number of neurosurgeons per capita at the HRR level was negatively associated with unemployment, poverty, and percent uninsured. CONCLUSIONS Regions characterized by low socioeconomic status have fewer neurosurgeons per capita in the United States. Low income, low number of college graduates, and high unemployment rate are associated with fewer numbers of neurosurgeons per capita. Further research is needed to determine if these geographical workforce disparities contribute to poor access to quality neurosurgical care.