Rural–Urban Disparities in Otolaryngology: The State of Illinois

Abstract

Objectives/Hypothesis To highlight rural–urban disparities in otolaryngology, and to quantify the disparities in access to otolaryngology specialist care across Illinois. Several studies across disciplines have shown increased prevalence and severity of disease in rural communities, relative to their urban counterparts. There is very little published quantifying a disparity in rural access to otolaryngologists. Study Design Population study. Methods Counties in Illinois were classified based on urbanization level on a scale from I (most urban) to VI (least urban) using the 2013 National Center for Health Statistics (NCHS) Urban–Rural Classification scheme. The six urbanization levels include four metropolitan (I–IV) and two nonmetropolitan levels (V and VI). The name and practice location of all registered otolaryngologists in Illinois were collected using the American Academy of Otolaryngology website (http://entnet.org). Population data were recorded from the most recent US Census (2010). Results Two hundred seventy‐eight academy‐registered otolaryngologists were identified in Illinois. One hundred fifty‐one of these providers were located in a single county categorized as a level I by the NCHS scheme. There are over 18,000 square miles and 600,000 persons living in NCHS level VI counties in Illinois with zero registered otolaryngologists. Overall, metropolitan counties (I–IV) averaged 1.32 otolaryngologists per 100,000 population, whereas nonmetropolitan counties (V and VI) averaged 0.46 otolaryngologists per 100,000 (P < .01). Conclusions There is a paucity of academy‐certified otolaryngologists with primary practice locations in rural counties of Illinois. There is a significant rural population and massive land area with limited spatial access to otolaryngologic specialist care. Level of Evidence NA Laryngoscope, 131:E70–E75, 2021

Practice Consolidation in Otolaryngology: The Decline of the Single‐Provider Practice

“… 26 Finally, large-scale practices, in a world with increased consolidation, may trend toward urbanization and ultimately widen health care disparities by limiting access to care in rural areas. 12 , 27 …”

“…26 Finally, large-scale practices, in a world with increased consolidation, may trend toward urbanization and ultimately widen health care disparities by limiting access to care in rural areas. 12,27 Given these concerns, further research is necessary to assess the influence of practice consolidation on health care costs, access, and quality of care in the field of otolaryngology. A continued trend toward large-scale practice consolidation could lead to the demise of the solo provider practice in otolaryngology, and given the potential implications on the delivery of quality health care services, the American Academy of Otolaryngology-Head and Neck Surgery and other national specialty societies should monitor these trends closely.…”

Rapid telehealth implementation into an otolaryngology practice during the COVID‐19 pandemic

“…Prior research among otolaryngology‐head and neck surgery patients has shown varying levels of online health (eHealth) literacy, with lower levels among rural populations 27 . Since rural populations have worse health outcomes, decreased access to care, and longer travel times, 28‐30 telehealth could help address many of these sources of disparities. However, interventions to overcome technical issues will be required to improve telehealth availability, education, and utilization among rural patients.…”

Characterizing Medicare Reimbursements and Clinical Activity Among Female Otolaryngologists

“…This pattern may be partially attributable to increased specialization and a higher likelihood of academic affiliation among urban ORLs, a more comprehensive practice among rural providers, as well as a higher density of Medicaid/ Medicare patients in rural areas. 41 Given the significantly higher prevalence of female ORLs practicing in urban areas (93.1%), there is a large difference in sample size between the geographic cohorts. In a comparison of regional trends, female ORLs in the Northeast accrued significantly more total Medicare payments and saw a higher number of unique Medicare patients than those practicing outside the Northeast, likely signaling differences in regional reimbursement rates, practice models, and Medicare population density.…”