(0250) Rural-Urban Otolaryngology Workforce Analysis: The State of Missouri

Introduction: Medical care in the United States is disproportionally located in urban areas despite the large population in rural areas where lower socioeconomic status and higher rates of comorbidities contribute to health disparities. The goal of this study is to analyze access to otolaryngology (OTO) practices in Missouri rural-urban with relationship to rural and urban populations.

Methods: This cross-sectional study identified OTO physician practice presence in Missouri. Physician and practice locations were identified using the MO Health Net Fee-For-Service database (Missouri Department of Social Services). Additional practice locations were identified by searching online directories of each hospital listed in MO Hospital Profiles By County database (Missouri Department of Health and Senior Services). Physicians with locations in multiple counties were included in each respective county during data analysis. Physicians were excluded if not found on an official practice/hospital website or who were training.

Results: In Missouri, 209 total licensed OTO physicians were identified. Collectively, urban counties (NCHS levels I-IV) were served by 243 physicians, and rural counties (NCHS levels V-VI) were served by 32 physicians (p=0.02). Per 100,000 people, urban counties averaged 5.21 physicians versus 2.11 physician in rural counties (p=0.32). Number of physicians per 100 square miles was 1.28 in urban counties 0.06 in rural counties (p = 0.18), despite 49,782 square miles of land (72.4%) in rural counties compared to 18,964 square miles (27.6%) in urban counties.

Conclusions: The majority of OTO physicians practice in urban counties. While more OTO physicians per population and per land area was noted, these were not statistically significant different likely due to wide county variance of OTO physicians as well as mitigation of disparity by our inclusion of outreach clinics. Future research can better study rural access by accounting for physician time spent at each clinical site, relative patient travel proximity to practices, and presence (or lack) of supporting hospital infrastructure.