EXPRESS: Bringing the Doctor to the Patients: Cardiology Outreach to Rural Areas

Clinical outreach is a crucial but understudied healthcare service delivery model. Physicians staffing rural outreach clinics must allocate a limited resource (i.e., their time) between caring for patients at their main sites and outreach locations. Using a unique 30-year dataset of decisions made by cardiologists, we estimate a constrained utility maximization model of time allocations across home and outreach locations. The results show that travel distance, potential competition, and patient demand for cardiology services significantly influence allocation decisions. This structural model is used to simulate the impact of a predicted reduction in cardiologist supply. The expected impacts are unevenly distributed, with some rural locations experiencing large decreases in access. We evaluate two policies to restore rural access: targeted immigration and a subsidy program. A subsidy program with an estimated cost of $406,000 can restore outreach after a 10% reduction in cardiologist supply. This option should be preferred to recruiting and supporting five additional cardiologists under a targeted immigration strategy. This research demonstrates the value of marketing modeling in addressing limited access to healthcare services and evaluating alternative policies for maintaining access in the face of coming physician shortages.