Surgical subspecialist distribution and Social Vulnerability Indices in the inland empire

Background

Access to surgical specialty care differs based on geographic location, insurance status, and subspecialty type. This study uses the Inland Empire as a model to determine the relationship between Social Vulnerability Indices (SVIs), surgeon sex, and surgical subspecialty distribution.

Methods

823 census tracts from the Centers for Disease Control's (CDC) SVI 2018 database were compared against 992 surgeons within 30 distinct subspecialties. This data was retrieved from the American Medical Association's (AMA) 2018 Physician Masterfile. Spearman's bivariate and multiple regression were used to compare the relationship between SVI and number of surgical subspecialists within each census tract.

Results

There were approximately 3.34 male and 0.35 female surgeons per census tract (t(267) = 7.74, p < 0.001). Significant inverse relationships existed between Cosmetic surgery, Urology and Minority status/language (ρ = −0.131 [95 % CI −1.000 to −0.028], p = 0.016; ρ = −0.142 [95 % CI −1.000 to −0.039], p = 0.010, respectively); General surgery, Socioeconomic status (ρ = −0.118 [95 % CI −1.000 to −0.014], p = 0.027), and Household composition/disability (ρ = −0.203 [95 % CI −1.000 to −0.102], p < 0.001); Hand surgery and Socioeconomic status (ρ = −0.114 [95 % CI −1.000 to −0.010], p = 0.031); Otolaryngology, Housing type/transportation (ρ = −0.102 [95 % CI −1.000 to 0.001], p = 0.047), and Overall Social Vulnerability (ρ = −0.105 [95 % CI −1.000 to −0.001], p = 0.043). Multiple regression analyses reinforced these findings.

Conclusions

This study concludes that social vulnerability is predictive of, and significantly linked to, differences in distribution of surgical subspecialty and surgeon gender. Future research should investigate recruitment of a diverse surgical workforce, infrastructural barriers to care, and differences in quality of care.

Key message

Our work demonstrates complex relationships between surgical subspecialist distribution, surgeon gender, and a census tract's various Social Vulnerability Indices. Thus, this research can serve to continue educating surgeons and other healthcare providers about the importance of social determinants of health in the construction of healthcare policy and practice, as well as incentivizing equitable recruitment of a diverse population of surgeons.