Review Article: Past, Present and Future of Cancer Survivorship and the Importance of the Urologist

Combining Drive Time and Urologist Density to Understand Access to Urologic Care

OBJECTIVE

To improve our understanding of timely access to urologic care, we leveraged driving time combined with a measure of urologist density.

MATERIALS AND METHODS

We identified all urologists who billed Medicare using National Provider Identifier in 2015 and geocoded their practice location. We developed drive-time based service areas for each provider using Esri's street network dataset stratified into 30, 60, 90, and 120-minute areas. Population characteristics were aggregated and block groups were assigned to a Hospital Referral Region.

RESULTS

We identified 10,170 urologists that billed Medicare in 2015 in the United States. Compared to the northeast, vast expanses of land across the western United States have drive times to urology care >60 minutes. However, less than 13% of the US population is unable to obtain urologic care within 30 minutes. Likely reflecting rural populations, White and American Indian populations are represented in greater proportion among those requiring a longer drive time to urologic care. Disparities were noted between areas with timely access to a high versus low density of urologists; low density areas have a greater proportion of Black and Asian populations and greater income inequality.

CONCLUSIONS

Drive time to urologists combined with urologist density is a novel approach to investigating urologic care access and a tool for health disparities research. While almost all of the US population lives within 1-hour drive time to a urologist there remains important differences in the population severed by high compared to low provider density.