Uribe-Leitz Tarsicio, Esquivel Micaela M, Garland Naomi Y, Staudenmayer Kristan L, Spain David A, Weiser Thomas G
Department of Surgery, Stanford University, Section of Trauma & Critical Care, Stanford, California.
Department of Surgery, Stanford University, Section of Trauma & Critical Care, Stanford, California.
J Surg Res. 2018 Mar;223:102-108. doi: 10.1016/j.jss.2017.10.014. Epub 2017 Nov 15.
Areas of minimal access to surgical care, often called "surgical deserts", are of particular concern when considering the need for urgent surgical and anesthesia care. We hypothesized that California would have an appropriate workforce density but that physicians would be concentrated in urban areas, and surgical deserts would exist in rural counties.
We used a benchmark of six general surgeons, six orthopedists, and eight anesthesiologists per 100,000 people per county to define a "desert". The number and location of these providers were obtained from the Medical Board of California for 2015. ArcGIS, version 10.3, was used to geocode the data and were analyzed in Redivis.
There were a total of 3268 general surgeons, 3188 orthopedists, and 5995 anesthesiologists in California in 2015, yielding a state surgeon-to-population ratio of 7.2, 6.7, and 10.2 per 100,000 people, respectively; however, there was wide geographic variability. Of the 58 counties in California, 18 (31%) have a general surgery desert, 27 (47%) have an orthopedic desert, and 22 (38%) have an anesthesiology desert. These counties account for 15%, 25%, and 13% of the state population, respectively. Five, seven, and nine counties, respectively, have none in the corresponding specialty.
Overall, California has an adequate ratio of surgical and anesthesia providers to population. However, because of their uneven distribution, significant surgical care deserts exist. Limited access to surgical and anesthesia providers may negatively impact patient outcome in these counties.
在考虑紧急外科手术和麻醉护理需求时，手术护理难以触及的区域，通常被称为“手术荒漠”，尤其令人担忧。我们推测加利福尼亚州会有合适的劳动力密度，但医生会集中在城市地区，农村县会存在手术荒漠。
我们使用每县每10万人有6名普通外科医生、6名骨科医生和8名麻醉医生的基准来定义“荒漠”。这些医疗服务提供者的数量和位置来自加利福尼亚州医疗委员会2015年的数据。使用ArcGIS 10.3版本对数据进行地理编码，并在Redivis中进行分析。
2015年加利福尼亚州共有3268名普通外科医生、3188名骨科医生和5995名麻醉医生，该州外科医生与人口的比例分别为每10万人7.2名、6.7名和10.2名；然而，地理分布差异很大。在加利福尼亚州的58个县中，18个（31%）存在普通外科荒漠，27个（47%）存在骨科荒漠，22个（38%）存在麻醉荒漠。这些县分别占该州人口的15%、25%和13%。分别有5个、7个和9个县在相应专业领域没有此类医生。
总体而言，加利福尼亚州外科和麻醉医疗服务提供者与人口的比例充足。然而，由于分布不均，存在显著的手术护理荒漠。在这些县，获得外科和麻醉医疗服务提供者的机会有限可能会对患者的治疗结果产生负面影响。
