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Geographic Maldistribution of the Plastic Surgery Workforce in the United States: County-Level Disparities in Relative Supply and Travel Distance
Lee D. Yang
*, Nadeem E. Jones, Michael B. Amrami, Jarrod T. Bogue
Columbia Vagelos College of Physicians and Surgeons, New York City, NY
Background: Plastic and reconstructive surgery (PRS) provides essential reconstructive, oncologic, and trauma-related care, yet national patterns in PRS distribution remain incompletely characterized.
Methods: County-level workforce and sociodemographic data from the 2023 Area Health Resources File were merged with U.S. Census county boundaries. To assess PRS distribution relative to overall physician supply, number of plastic surgeons per county from the American Medical Association Physicians Master File was modeled using negative binomial regression with a log link and offset for the log of total active physicians. Demographic and socioeconomic variables, rurality, and state fixed effects were included as independent variables. Geographic access was assessed by computing straight-line distances from each county centroid to the nearest county with ≥1 plastic surgeon.
Results: Among 3144 counties, 2376 (76%) had no plastic surgeons and 148 (5%) had no active physician at all. Higher median income was associated with increased PRS supply (+3.7% per $10,000, p=0.017), while higher unemployment was associated with reduced PRS supply (-1.3% per 10% increase, p<0.001). Compared with metropolitan counties, micropolitan counties had 48.5% lower relative PRS rates and rural counties had 63.9% lower rates (both p<0.001). Median distance to the nearest county with a plastic surgeon was 27.8 miles. Maximum distance was 886.6 miles, reflecting remote Alaskan counties. Population weighted median travel distance to the nearest plastic surgeon was highest for Wyoming (64.6 miles) and North Dakota (35.4 miles). >100,000 Americans resided in counties >200 miles from the nearest plastic surgeon, and nearly 15,000 resided >500 miles away.
Conclusion: Plastic surgeon distribution in the United States is strongly correlated with economic structure and rural-urban status. Addressing these disparities will likely require targeted strategies such as support for regional referral networks, expansion of telehealth-based perioperative care, and development of rural surgical infrastructure.
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
Back to 2026 Abstracts
Models adjusted for BMI, tissue expander size, and axillary irradiation. OR > 1 indicates higher odds with early exchange.
