A lack of access to gastroenterologists and hepatologists exists across the United States, causing many patients to have to travel long distances to receive specialty care. Arun B. Jesudian, M.D., a transplant hepatologist at NewYork-Presbyterian and Weill Cornell Medicine, recently co-authored a paper published in Gastroenterology that highlights the findings from a cross-sectional study examining geographic disparities in access to physicians and the unmet needs that exist in gastroenterology care in non-metropolitan versus metropolitan counties in the United States.
Below, Dr. Jesudian shares how non-metropolitan areas lack access to a nearby gastroenterologist, how this affects health outcomes, and potential solutions for closing gaps in areas where there is a low density of gastroenterologists.
Non-Metropolitan Counties Have Fewer Specialists
Our paper is the first-of-its-kind to address whether United States residents have access to a local gastroenterologist. Similar studies examining access to care in other medical specialties found geographic disparities between metropolitan and non-metropolitan areas, and we were curious to see if the same patterns hold in gastroenterology. Anecdotally, we know that access to a GI specialist outside of a metropolitan area is difficult, but we wanted to obtain the data to confirm that.
We found that 7 million people in the United States live more than 50 miles away from the nearest gastroenterologist, and 45 million people (about 14% of the population) live more than 25 miles away from the nearest gastroenterologist.
Of the 3,149 counties included in our study:
- 69.3% did not have any gastroenterologists
- 16.8% had five or fewer gastroenterologists
In major metropolitan areas like New York, we see the full spectrum of gastrointestinal conditions. But in rural and remote areas, it is much harder for patients to access these services that we can take for granted.
— Dr. Arun B. Jesudian
Thirty-nine percent of the 1,167 metropolitan counties had no gastroenterologists as compared to 87.4% of the 1,975 non-metropolitan counties. The states with the highest rates of gastroenterologists per 100,000 people were Massachusetts (8.5), Connecticut (8.2), and New York (7.7); Alaska (1.5), North Dakota (1.9), and Wyoming (2.4) had the lowest rates.
How the Absence of Nearby Gastroenterologists Impacts Patient Care
In major metropolitan areas like New York, we see the full spectrum of gastrointestinal conditions, from regular colon cancer screening to subspecialty care for inflammatory bowel disease or liver disease. But in rural and remote areas, it is much harder for patients to access these services that we can take for granted.
For example, some patients may be eligible to do colon cancer screening with an at-home stool test; however, many patients require a colonoscopy performed in their physician’s office or at a hospital. If patients are unable to schedule the procedure near their home, they may forgo the colonoscopy. This can lead to higher rates of colorectal cancer. The same is true for managing chronic liver disease and cirrhosis if patients are not able to see a nearby hepatologist.
Patients who have chronic gastrointestinal conditions, including Crohn’s disease, ulcerative colitis, cirrhosis, and motility disorders, often require expertise and services that their primary care provider does not possess. Without easy access to a nearby gastroenterologist or hepatologist, these patients may experience delays in receiving proper diagnostic tests and medication and other treatments.
Potential Strategies to Mitigate the Shortage of Gastroenterologists and Hepatologists
The issue of access is not something we are going to solve overnight. Telehealth allows us to reach patients who live far away from specialists, but it is not a perfect solution. It is impossible to perform procedures, like endoscopies and colonoscopies, remotely or manage a patient with complex disease on a fully virtual basis.
Therefore, another area of focus for closing gaps in access to care is GI outreach programs in which gastroenterologists and hepatologists at larger metropolitan practices periodically see patients who do not have local access to GI care in their county. Healthcare systems could set up clinic spaces for subspecialty care to serve communities that are distant from major health networks.
Additionally, increasing the gastroenterology workforce would help alleviate shortages. Having more physicians and advanced practice providers who specialize in gastroenterology is a significant part of the solution. We should also be incentivizing gastroenterology trainees to consider practicing in non-metropolitan areas. With all of these solutions, it is possible that we could move the needle and open up access to GI care in underserved areas in the country.
