New Research Reveals Geographic Disparities in GI Specialist Access

Recent research has uncovered significant geographic disparities in the availability of gastroenterologists across the United States, revealing limited access to care for patients, especially in rural and low-income areas. The study highlights stark contrasts between urban and rural regions, with areas in the Midwest and Southwest facing the greatest shortages of specialists.

“This is the first nationwide study to comprehensively assess the density of GI specialists at a granular, local level across the US,” stated Jonathon Casey Chapman, MD, a gastroenterologist at Gastroenterology Associates in Baton Rouge, Louisiana. The findings offer critical insights into the distribution of specialists relative to the population of patients with inflammatory bowel disease (IBD).

Understanding the evolving management of IBD is crucial, particularly as treatment options expand. Recently, the US Food and Drug Administration (FDA) approved a single-injection, once-monthly maintenance regimen of Omvoh (mirikizumab-mrkz) for adults with moderately to severely active ulcerative colitis (UC), along with upadacitinib (Rinvoq) for similar patient profiles. Despite these advancements, barriers such as insurance limitations, costs, and access to specialists persist, complicating patient care.

Study Details and Findings

The retrospective analysis utilized multiple data sources to determine the density of gastroenterologists at both state and local levels, employing the first three digits of US postal codes (ZIP codes) as geographical markers. Researchers calculated the density of patients with IBD per 100,000 population, gastroenterologists per 100,000 population, and the number of gastroenterologists per 100 patients with IBD. The analysis incorporated data from 2022 claims, the 2022 National Provider Identifier registry, and the 2020 US Census for demographic variables.

In total, the study analyzed data from 520,020 patients with IBD. At a national level, the density of patients with IBD was found to be 156.9 per 100,000 population. State-level variations were notable, with Maine reporting the highest density at 337.1 and New Mexico the lowest at 58.2.

At the local level, the study revealed that 65.7% of the examined ZIP code tabulation areas (ZCTAs) had a density of <100 to <250 patients with IBD per 100,000 population, while 24.6% reported a density of less than 100. The analysis identified 21,611 GI specialists from the 2022 NPI registry, revealing an overall national density of 6.5 GI specialists per 100,000 population.

States like Kansas and Wyoming exhibited the lowest densities at 2.0 and 3.1 specialists per 100,000 population, respectively, whereas New Jersey and Rhode Island reported the highest at 11.2 and 10.8, respectively.

Implications for Healthcare Policy

The findings indicate a significant disparity in the availability of gastroenterologists. Nationally, the density of gastroenterologists per 100 patients with IBD was 4.2. In states like Kansas, the figure dropped to 1.4, while Michigan, with 23,969 patients with IBD, reported a low density of 2.2 gastroenterologists per 100 patients with IBD.

Further analysis revealed alarming statistics: one-fifth of ZIP codes had a gastroenterologist density of less than 1 per 100 patients with IBD, and over one-third reported densities between 1 and <5. Across the nation, 130 ZCTAs had no gastroenterologists available for every 100 patients, with 62% of these ZIP codes situated in rural areas and 25% recording household incomes below 150% of the poverty line.

Researchers noted that areas with a higher density of gastroenterologists tended to have lower poverty rates and were more urbanized than those with fewer specialists. “This study shows that despite the burden of IBD in the US, the geographic distribution of gastroenterologists varies widely,” the authors concluded. “Rural areas and low-income regions have fewer gastroenterologists than urban areas, highlighting disparities in specialist availability.”

The implications of this study may inform healthcare policies aimed at improving resource allocation for underserved populations with IBD throughout the United States. By addressing these disparities, the healthcare system can better support patients who face significant obstacles in accessing necessary gastrointestinal care.