Initiatives to establish contact with pediatric specialties shorten the travel time to the doctor

There is a shortage of pediatric subspecialists (doctors who treat children with complex conditions) in the United States, and the availability and distribution of these health care professionals may be insufficient to meet the health care needs of children.

In a new study, researchers examined child health care in Maine to determine the impact of pediatric specialty clinics on access to the nearest pediatric specialists. The study found that the presence of these clinics significantly reduced travel time to specialty doctors, especially for children living in rural areas of the state.

The study by researchers from Carnegie Mellon University, Tufts University, MaineHealth and Northern Light Health was published in BMC Pediatrics.

“Nearly a quarter of U.S. families who require treatment from a child specialist report difficulty obtaining that treatment,” explains Kristen Kurland, professor of architecture, information systems and public policy at Heinz College of Carnegie Mellon University and co-author of the study. “Children referred to child specialists often have to wait months or travel hundreds of miles before receiving treatment, and the problems are even greater in rural areas.”

Recent studies highlighting the shortage of pediatric specialists have found large differences in the distance between children and the nearest specialists, but these studies do not take into account the specialty clinics that specialists regularly visit. Pediatric specialists include pediatric cardiology, gastroenterology, endocrinology, neurology, genetics, pulmonology and nephrology.

In this study, researchers used 2022 administrative data (including the schedule and locations of pediatric specialty clinics) from two health systems in Maine, the second most rural state in the country, to estimate travel time from each zip code area to the nearest specialty clinic, with and without accounting for outpatient clinics. Using 2020 census data, they calculated travel times for the state’s entire child population, as well as for children living in urban and rural areas.

Of more than 207,000 people under age 20 in the state, the study found that 68% lived closer to a consultation center than to a clinical center. The impact of the consultation clinics varied by specialty and was concentrated among children in rural areas, who were farthest from the clinical centers. In the seven specialties where consultation clinics were offered, the clinics reduced the average travel time to the nearest pediatric specialist by 5 to 26 minutes for all children and by 16 to 46 minutes for children from rural areas.

Based on their findings, the authors conclude that pediatric specialty clinics can significantly reduce travel time to the nearest pediatric specialist, particularly for children living in rural areas. They note that assessments of access and barriers to pediatric specialty care that do not include specialty clinics may underestimate access. They also suggest that policymakers should consider expanding the number of specialty clinics to improve access.

However, the impact of outreach clinics on improving access may be mitigated by the relative infrequency with which they are scheduled. Of the 25 specialty-site combinations, 16 clinics occurred 12 times or fewer in 2022 and 10 occurred six times or fewer.

Limitations of the study, the authors note, include that their data are based on only one state, and results for other locations may vary depending on the distribution of clinical centers and field offices. Additionally, the study did not account for travel across state lines, use of public transportation, car ownership, or innovations such as telemedicine. Nor did it examine patient or family perceptions of need for care, desire for care, ability to pay for care, or other aspects of access.

“Children in rural Maine face significant disparities in geographic access to health care, particularly for specialties offered at only one clinical center or at relatively few outpatient sites,” notes James C. Bonhoff, professor of pediatrics at Tufts University and a pediatrician at MaineHealth who led the study.

“More information about the current availability – and ideally use – of outreach clinics will enable more accurate assessments of the true state of geographic access to pediatric specialty care and may also facilitate decisions by health systems and states to support these initiatives.”