Is there a geographic shortage of breast reconstructive plastic surgeons in the US?
Teng L. Teng1, Ryan Hall1, Roger Graham, MD2, Julieann Reiland, MD3, Abhishek Chatterjee, MD, MBA2.
1Tufts University School of Medicine, Boston, MA, USA, 2Tufts Medical Center, Boston, MA, USA, 3Avera Medical Group, Sioux Falls, SD, USA.
Background
Breast surgery requires oncologic resection by the breast surgeon and reconstruction by the plastic surgeon. Despite the Federal Breast Reconstruction Law mandating insurance coverage breast reconstruction rates remain low. One of the contributing factors may be the geographical access to plastic surgeons. We conducted a study to determine the geographic distribution of plastic surgeons compared to the geographic distribution of breast surgeons in the US.
Methods
A database investigation of the 2018 membership for both the American Society of Breast Surgeons (ASBrS) and the American Society of Plastic Surgeons (ASPS) was performed. From the ASBrS website, we obtained a list of zip codes of all the registered breast surgeons (2,807 members representing 1,807 unique zip codes). The list of zip codes was filtered to include only mainland United States resulting in 1,725 entries. Each of the zip codes was searched in the ASBrS website, where the number of breast surgeons within 10 miles was recorded. The same zip codes were similarly searched in the ASPS website, where the number of plastic surgeons (who described themselves as interested in breast reconstruction) within 10 miles and the distance of the closest plastic surgeon outside 10 miles were recorded. We categorized each of the zip codes as urbanized areas, urban clusters, or rural according to the United States Census Bureau classification based on the 2010 census.
Results
Currently, 25% of US breast surgeons have no access to plastic surgeons within a 10 mile radius. Expanding the radius to 20 miles, 15% of breast surgeons have no plastic surgeon access. In general, surgeons are heavily concentrated in urban areas. Eighty-seven percent of surgeon zip codes were from urbanized areas (Table 1). In the urbanized areas, there are more plastic surgeons than breast surgeons. Outside the urban areas, there are substantially more breast surgeons per zip code than plastic surgeons. Particularly, while rural areas have one breast surgeon per zip code, there are often no plastic surgeons available.
| Zip code entries | Average number of breast surgeons | Average number of plastic surgeons | |
| Urbanized areas | 1,497 | 7.03 | 10.97 |
| Urban clusters | 211 | 1.14 | 0.23 |
| Rural areas | 17 | 1.00 | 0.06 |
Conclusion
There is a geographical disparity of plastic surgeons compared to breast surgeons, suggesting a patient access barrier to breast reconstruction. A quarter of breast surgeons have no immediate access to plastic surgeons. While both breast surgeons and plastic surgeons have more presence in urbanized areas compared to rural areas, the distribution of plastic surgeons is polarized to the urban setting, leaving physicians in the rural setting and their patients without options for breast reconstruction.
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