Geographic disparities in access to gynecologic oncologist subspecialty care

Document Type

Abstract

Publication Date

9-1-2025

Abstract

Objectives: Although advancements have been made in the treatment of gynecologic malignancies, health disparities persist, preventing equal access to treatment. Unequal cancer burden is endured by patients of lower socioeconomic status, racial minorities and those living in geographical areas remote from subspecialty care. Survival disparities have been observed in several studies and attributed to differences in regional socioeconomic factors and access to treatment and post-treatment follow-up. Little has been formally studied on census data about the distribution of the gynecologic oncology workforce. This study aimed to define the geographic distribution of the gynecologic oncology workforce compared to the general population. The secondary aim was to define the differences in access to general obstetrician/gynecologist (OB/GYN) care versus subspecialty care. Identifying geographic regions with limited access to gynecologic oncology specialists may aid in efforts to improve disparities in gynecologic cancer care. Methods: OB/GYN generalists practicing in the United States (U.S.) were tabulated using 2021 Association of American Medical Colleges (AAMC) physician workforce profile data. Gynecologic oncologists (GOs) practicing in the U.S. were identified using the National Plan and Provider Enumeration System (NPPES) registry using specialty taxonomy codes. Physician location was determined by zip code listed in the NPPES registry. U.S. Census data was queried to estimate the female population by state (based on the 2020 U.S. Census). The relationships between OB/GYN generalists, GOs and the U.S. female population were calculated. The density of OB/GYN generalists and GOs per 100,000 females was geographically mapped (Fig. 1). Results: A total of 42,889 OB/GYN generalists and 2284 gynecologic oncology subspecialists were identified. All 50 states and two U.S. territories had at least some generalist OB/GYN physicians. North Dakota and Wyoming lacked any GOs. Across 50 states and two U.S. territories, there was a median of 24.1 OB/GYN generalists and 1.33 GOs per 100,000 females. The District of Columbia had the highest density of generalists, with 69.4 per 100,000 females. Comparatively, Arizona had the lowest density of generalists at 7.48 per 100,000 females. District of Columbia had the highest density of GOs, with 3.92 per 100,000 females. In contrast, Puerto Rico had the lowest density of subspecialists, after North Dakota and Wyoming, at 0.47 per 100,000 females. There was significantly greater geographic clustering among subspecialists than generalists. Conclusions: Geographic disparities in access to GOs compared to general OB/GYN are identified in this study, highlighting inequities in specialized care in the U.S. Unlike generalist care, which is more widely available, GOs are often concentrated in urban or well-resourced areas, leaving rural and underserved patients at a disadvantage. This gap in access leads to delayed diagnoses, suboptimal treatments and poorer outcomes for patients. Addressing these disparities is essential to ensuring equitable health care, improving survival rates and enhancing the quality of life for patients across diverse regions. Policy interventions, resource reallocation and improvements in health care infrastructure are required to mitigate these inequities to ensure that all women, regardless of location or social determinants, receive timely and specialized care. [Formula presented]

Publication Title

Gynecologic Oncology

Volume

200

Issue

Supplement 1

First Page

158

Last Page

158

Comments

Society of Gynecologic Oncology (SGO) 2025 Annual Meeting on Women's Cancer held 2025-03-14 to 2025-03-17 in Seattle, Washington, USA.

This document is currently not available here.

Open Access

Share

COinS