If it seems like your patients are coming from a lot further away these days, that might because nearly half of U.S. counties don’t have a single cardiologist working there.
Researchers from Brigham and Women’s Hospital teamed up with GoodRx to analyze data from all 3,143 counties in the US, finding that 46.3% of U.S. counties don’t have a single cardiologist, and this regional cardiologist imbalance often results in…
- Much Longer Patient Drives – The 22M people who live in these “cardiology desert” counties have to drive an average of 87.1 miles round trip to see their cardiologist, versus just 16.3 miles for patients who live in counties with cardiologists.
- Exacerbated Inequalities – Unsurprisingly, 86.2% of those cardiologist-less counties are rural, where patients tend to be poorer and sicker. In fact, patients in no-cardiologist counties had 31% higher CV risk index scores (2.8 vs. 2.1) and worse access to healthy foods (7.2 vs. 7.6 scores).
- Urban Physician Density – Counties with cardiologists have an average of 24 local cardiologists, although 10% of those counties had just one cardiologist (who is likely overworked).
- PCP Pressure – The rural cardiologist shortage also places more responsibility on primary care physicians, although cardiologist-less counties also have far fewer PCPs than counties with cardiologists (40.8 vs. 63.2 per 100k residents).
The authors believe that cardiology care’s rural/urban divide is growing wider, and clearly show that it’s having a major impact on outcomes, since cardiologist-less counties had higher age-adjusted cardiovascular mortality rates versus counties with cardiologists (281 vs. 269 per 100k adults) and one year shorter life expectancy.
The solution? The authors highlight digital health’s potential to bridge geographic gaps to cardiovascular care, but also endorse incentivizing more clinicians to practice in rural areas, and better integrating cardiovascular care with primary care (especially regarding CVD prevention and risk modification).
The Takeaway
This is far from the first time that we’ve covered rural America’s problems with cardiovascular care and access, and identifying a problem is a key step towards solving it. However, this latest data suggests that big changes will have to happen before we see meaningful improvements to rural cardiovascular care.
