Characterizing the geographic distribution of vascular surgeons in the United States.

OBJECTIVE: The shortage of vascular surgeons can be attributed to multiple factors, including an aging population, the increasing demand for vascular surgeons, and an aging vascular surgery workforce. The distribution of vascular surgeons across the United States varies by locale; thus, the shortage affects regions of different sizes disproportionately. We collated the geographic data to characterize the current distribution of vascular surgeons with an emphasis on the practice location, population density, and population age. METHODS: Vascular surgeons were identified using the Physician Compare National Downloadable file from the Centers for Medicare and Medical Services. The counties were matched with each surgeon's practice location. The locations were categorized into metropolitan, urban, or rural using the rural-urban continuum codes. Census Bureau data were used to match all counties with their population-level metrics. The distribution of vascular surgeons was analyzed by comparing the number of counties served, total patient population served, and patient population aged >50 and >65 years served. Finally, the density of vascular surgeons in the United States for the total population and for those aged >50 and >65 years was calculated. RESULTS: In 2018, the U.S. population was 309.8 million, and there were 3145 counties. Of the 3145 counties, 533 (17%) had had a practicing vascular surgeon. The combined population of these counties was 213.8 million people (69% of the U.S. population). Stratified by age, the vascular surgeons in these 533 counties could treat 37.3 million people aged >50 years and 17.4 million people aged >65 years. However, 2612 counties (83%), with a total population of 96 million people (31% of the U.S. population), had had no practicing vascular surgeon. When stratified by age, 78.1 million people in the uncovered counties were aged >50 years and 35 million were aged >65 years. Of the 2612 uncovered counties, 48% were urban and 24% were rural. CONCLUSIONS: We found a nationwide shortage of vascular surgeons, with urban and rural areas disproportionately affected negatively. Although encouraging vascular surgeons to practice in underserved areas would be an ideal solution, it is not pragmatic. Therefore, developing alternatives such as using primary care providers, investing in telehealth and developing transfer systems could be viable methods of providing vascular care to geographically isolated populations. These findings have significant implications for hospitals, patients, and vascular surgeons, who would all stand to benefit from efforts to address these disparities.

Bedside Diagnostics for Infections: A Guide for Dermatologists.

In dermatology, there are many bedside diagnostic tests that may aid in more rapid diagnosis and early initiation of appropriate therapy. When performed correctly, these bedside diagnostic tests can provide both sensitive and specific results. We discuss bedside diagnostic tests, such as the Tzanck smear, potassium hydroxide (KOH) preparation, and mineral oil preparation, with a specific focus on their use in diagnosing infectious dermatoses.