The lion’s share of palliative care physicians dwell in more densely populated communities, creating disparities among the rural seriously ill population.
Recent research has found that more than 90% of board certified palliative physicians and nurse practitioners nationwide were located in metropolitan and urban areas in 2022. Only 10% of these palliative clinicians were in areas with the lowest socioeconomic levels. The study appeared in a recent issue of the Journal of General Internal Medicine.
Demand for palliative care is outpacing the growth of these programs, according to researcher Yingtong Chen, biostatistics data analyst at the Icahn School of Medicine at Mount Sinai.
Complicating the supply-demand issue further is a widespread variation in palliative care services and training across the country, with fewer resources available in rural regions compared to others, Chen said at the American Academy of Hospice and Palliative Medicine (AAHPM) and the Hospice & Palliative Nurses Association (HPNA) Annual Assembly.
“Demand is growing faster than the supply in terms of specialty and palliative care providers. The current capacity is insufficient,” Chen said during the assembly. “This is what made us interested in studying the geographic distribution and specialty training of quality of care providers.”
Chen, co-author of the study, was among the researchers from the Icahn School of Medicine at Mount Sinai that recently examined the scope of disparities in the geographic distribution of palliative care clinicians in the United States.
The findings highlight an uneven geographic distribution of board certified palliative medicine clinicians, which is tied to metropolitan areas and socioeconomic status, Chen stated. A lack of trained professionals is fueling disparities in palliative care access, she added.
“Depending on the state where you live, there is going to be a very different number of board certified providers,” Chen said. “There is disproportionality located in areas with higher socioeconomic status. The density of clinicians is particularly low in rural areas and areas with higher social economic depression, suggesting disparities in access to palliative care specialists.”
Higher volumes of palliative care physicians were found in regions such as California, Connecticut, Delaware, Maryland, Massachusetts, southern New York and in Washington D.C., according to Chen. Multiple states had “very few” or minimal “clusters” of palliative clinicians, including Alaska, Nevada, North Dakota and Wyoming, she added.
The nation is facing a mounting deficit of palliative care providers, Chen indicated.
Only one palliative care physician existed per 8,632 seniors 65 and older in 2022, according to the research. Additionally, only one palliative nurse practitioner existed per 22,380 seniors in the same age group.
Greater palliative education and training resources are needed to improve access, according to Chen. Additionally, wider access to telepalliative services could help ease capacity strains among a limited workforce, particularly in rural regions, she indicated.
“Looking ahead, to overcome these disparities we need to implement incentives for conditions to practice in underserved areas and expand rural poverty care programs,” Chen said. “Telemedicine [that] enable solutions that focus on user experience and reaching a more generalized population are essential to ensure access to palliative care specialist and improve care for patients with serious illness and their caregivers.”
