Disparities in Access to Palliative Care: Geographic Distribution of Palliative Care Specialists in 2022

Outcomes 1. Describe the geographic distribution of hospice and palliative medicine board-certified physicians and nurse practitioners in the United States.2. Compare the distribution of hospice and palliative medicine board-certified physicians and nurse practitioners by state, metropolitan status, and area-level socioeconomic status. Key Message Our study highlights the ongoing scarcity of palliative care specialists and striking differences in the geographic distribution of board-certified palliative medicine physicians and nurse practitioners based on geography. Disparities in access to palliative care appear to exist based on state, metropolitan status, and area-level socioeconomic status. Context Access to palliative care is impeded by significant shortages of Hospice and Palliative Medicine (HPM) board-certified physicians and nurse practitioners (NPs). Objectives To describe the geographic distribution of HPM board-certified physicians and NPs in the US and compare distribution by state, metropolitan status, and area-level socioeconomic status. Methods We merged the American Board of Medical Specialties HPM physician certification dataset and the Hospice and Palliative Nurses Association nurse practitioner certification dataset, including only those with active certifications in 2022. Based on available data, we mapped physicians by zip code and NPs by city/town (Rural-Urban Commuting Area Codes) to describe the percentage of clinicians in metropolitan areas. We calculated clinician density per state adjusted for population ≥ 65 years (2021 US Administration for Community Living) as a surrogate for palliative care needs. We calculated the Social Deprivation Index (SDI) associated with each physician's zip code and reported percentage of physicians per SDI quintile with lower quintiles indicating lesser deprivation and higher quintiles indicating greater deprivation. Results In 2022, there were 6,448 (72.2%) active physicians and 2,487 (27.8%) active NPs. More than 90% (n = 8,319) were located in metropolitan areas, and > 50% of physicians were in the two lower SDI quintiles (n = 3,613). Nationally, there was one physician per 8,632 people ≥ 65 years of age and one NP per 22,380 people ≥ 65 years. State-by-state population-adjusted rates of board-certified clinicians per 100,00 people ≥ 65 were highly variable. Conclusions Our findings highlight geographic differences in the distribution of HPM clinicians with the distribution of NPs mirroring that of physicians, such that NPs may be increasing access in areas where capacity already exists. Clinician density is particularly low in rural areas and areas with higher social deprivation, suggesting disparities in access to palliative care. Keywords Scientific Research / Advocacy / Policy/ Regulations