Rural Representation: Factors Associated With Geographic Distribution of Plastic Surgeons in Rural United States Counties.

Background: Residents of rural areas in the United States (US) experience health care disparities, including limited access to plastic and reconstructive surgery (PRS). This study aims to characterize the geographic distribution of board-certified plastic and reconstructive surgeons in the US and factors associated with their presence in rural areas.

Methods: We identified American Society of Plastic Surgeons members in the US in December 2023. We queried the 2022 Area Health Resource File for county demographics and health resources and characterized rurality with the National Center for Health Statistics Urban-Rural Classification Scheme. We used t test, chi-squared test, and Wilcoxon rank-sum test to compare intercounty outcomes and multivariate regression to identify health resources associated with PRS.

Results: We identified 3913 board-certified plastic and reconstructive surgeons who served 626 (20%) counties throughout the US, accounting for 247,988,122 (75%) people. Almost half (46%) of all urban counties had a plastic and reconstructive surgeon while only 5% of rural counties did ( P < 0.001). Access to PRS in a rural county was significantly associated with the presence of ambulatory surgery centers (adjusted odds ratio [aOR]: 1.80, P = 0.048), dermatology (aOR: 2.12, P = 0.010), and radiation oncology (aOR: 2.16, P = 0.013).

Conclusions: We found significant geographic variation in PRS access throughout the country, with 95% of rural counties being without a plastic and reconstructive surgeon. Presence of an ambulatory surgery center, dermatology, and radiation oncology increased the likelihood of access to PRS in rural counties. Additional studies are needed to identify necessary resources that may help recruit plastic and reconstructive surgeons to rural areas.