You may not think about finding a cardiologist every day like you might a coffee shop or a gas station. But what if one day you suddenly have a major heart problem—like a heart attack—you know the kind of thing that can’t quite wait? Well, don’t assume that cardiologists are like Starbucks—that finding them will be easy. Millions of people in the U.S. live in what’s considered “cardiology deserts,” defined as locations that completely lack cardiologists, according to a research letter recently published in the Journal of the American College of Cardiology. In fact, the study that formed the basis for this research letter found that nearly half of all U.S. counties do not have a single cardiologist.
Yes, that’s right. A total of 1,454 counties in the U.S.—or 46% of them—had no practicing cardiologists in 2023. These no-cardiologist counties encompass around 22 million U.S. residents. In each of these cardiology desserts, you will not be able to find anyone who specializes and is adequately trained in diagnosing and treating different types of heart disease.
That can leave you feeling a little “deserted” if you are having a heart attack in one of these counties. Will you be able to find anyone who can do an emergency cardiac catheterization, the kind of procedure needed for your heart to go on, in the words of that Titanic song? Chances ain’t good. And your heart is pretty darn important to life and stuff like that. Yeah, such a finding certainly does not merit a heart emoji.
These alarming findings emerged after a team from Brigham and Women’s Hospital in Boston, Massachusetts (Jeong Hwan Kim MD and Haider J. Warraich MD) and GoodRx in Santa Monica, California (Trinidad Cisneros PhD, Amanda Nguyen PhD and Jeroen van Meijgaard PhD) pulled data from Healthlink Dimensions to determine the locations of practicing cardiologists. They then overlaid these locations on a map of all the U.S. counties to yield the following yikes map:
As you can see, a large proportion of these counties in orange (i.e., cardiology deserts) fall in the Southern U.S. And surprise, surprise, people living in the Southern U.S. tend to have poorer heart health compared to people in other parts of the U.S., based on a publication in Mayo Clinic Proceedings.
Many of these cardiologist desert counties are in rural areas with 86% of entirely rural counties not have a single cardiologist. But you may say, why can’t people in such location just use telehealth to see cardiologists? Oh, that’s right, people in rural counties are less likely to have Internet access. Plus, you can’t do a cardiology procedure like a cardiac cath over telemedicine. Imagine the doctor saying, “OK, now after you give yourself anesthesia, thread that catheter into your vein.”
Here’s another shocker. Black Americans disproportionately lack access to cardiologists. Yes, I know, I know, it’s stunning to hear that a racial minority has less access since all the resources and wealth in the U.S. are so evenly distributed among different racial and ethnic groups, right? Nevertheless, the study found that over 16.8 million Black Americans live in counties with limited or no access to cardiologists with over two million living in counties with no such specialists at all. In fact, take a look at the states with the highest number of cardiology desert counties: Georgia, Mississippi, Virginia, Alabama, and Louisiana. Each of these have significant Black populations.
Take these findings to heart. But not just to the heart. Tori Marsh, MPH, Director of Research at GoodRx, explained that this was just the latest analysis conducted by Good Rx and collaborators that suggested the presence of many medical and health care deserts. “Back in 2020, we did pharmacy desert analyses that showed many of the same locations lacked pharmacies,” Marsh said. As she added, it’s highly likely that other health services are lacking in areas that are cardiology desserts. It’s not as if officials in a county say, “Let’s take care of every part of the body besides the heart because we want a total eclipse of the heart.”
This is not a simple problem to fix. “A lot is done to set up practices,” Marsh emphasized. “It can be affected by things such as baseline insurance access.” She spoke of needing to change the conditions and systems in these cardiology deserts to convince more cardiologists to move to remote areas. And of course different areas of health and medicine are connected in a system like body parts are. Just like you don’t see the rectum and the heart running off in different directions, you need different specialists to be in an area so that they can interact.
Marsh did indicate that some of the next steps may be to look at other populations —such as other racial minorities and immigrants—to see how their access to health care services may be limited as well. It will not be surprising to find that other populations are facing various disparities to health care access because they too have disparities in health and wellness levels and outcomes. After all, poorer health access typically is connected to worse health outcomes.
Now, in case you think cardiology deserts are only problems for those living in such deserts, you have to have a change of heart. If these deserts are ultimately leading to worse health outcomes, they can affect you, assuming that you pay taxes and for health insurance both of which may increase to cover the costs of health problems. Plus, you never know when you might be having an emergency while in one of these deserts.
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