JMIR Publications

ABSTRACT

Background:

There is a growing gap between surgeon availability and demand for orthopedic services in the United States. This study analyzes the geographic trends of this gap with a Relative Demand Index to guide precision public health interventions such as resource allocation, residency program expansion, and workforce planning to specific regions.

Objective:

Regional disparities in access to orthopedic care can be addressed with increasing orthopedic residencies based on our findings. We used publicly available online data to correlate the supply of orthopedic surgeons and demand for them across the United States.

Methods:

Data is from the US Census Bureau, AAMC ERAS directory, AAMC State Physician Workforce Data Report, and Google Trends. We calculated a normalized Relative Search Volume (RSV) and Relative Demand Index (RDI) and analyzed their relationship to the densities of orthopedic surgeons across the United States. We examined disparities with Spearman's rank correlation coefficient.

Results:

Orthopedic surgeon density, normalized to the highest density in our data, varies across the country, with the highest densities in Alaska (n=100), the District of Columbia (n=96), and Wyoming (n=72), and the lowest in Texas (n=0), Arkansas (n=6), and Oklahoma (n=64). States with the highest RDI values are Utah (n=97), Florida (n=88), and Texas (n=83), while those with the lowest are Alaska (n=0), the District of Columbia (n=5), and New Hampshire (n=7). Seven states lack orthopedic surgery residencies: Alaska, Maine, South Dakota, Wyoming, Montana, Delaware, and Idaho. In 2023, New York (n=19), Michigan (n=17), Ohio (n=17), Pennsylvania (n=16), and California (n=16) had the most residency programs.

Conclusions:

This study highlights the novel application of RDI to map regional need for orthopedics, and with this map, allow for better targeted resource allocation to expand orthopedic surgery training. The availability of orthopedic surgeons varies significantly across the US, with higher demand in southern states. Demand and supply, which RDI and orthopedic surgeon density represent, respectively, are strongly correlated negatively (r=-0.791, P<.001). States with more than fifteen residency programs still have a high demand (r=0.455, P<.001) for orthopedic surgeons.