INTRODUCTION: To quantify geographic access disparities to urogynecology and reconstructive pelvic surgery (URPS) subspecialists using real-world drive-time analysis, identifying populations unable to access complex pelvic reconstructive procedures and advanced minimally invasive gynecologic surgery. Twenty-five million American women lack timely access to fellowship-trained urogynecologists for complex pelvic surgery, with American Indian and Alaska Native populations experiencing the most severe disparities, yet racial minorities paradoxically achieve better access than White women due to extreme metropolitan concentration of subspecialists. OBJECTIVE: To quantify geographic access disparities to URPS subspecialists using real-world drive-time analysis and identify “surgical deserts” where women face significant barriers to specialized care. METHODS: We analyzed 901 FPMRS subspecialists from 2024 National Provider Identifier System data with active U.S. practices across 49 states, DC, and Puerto Rico. Using HERE Maps API, we calculated drive-time isochrones (30, 60, 120, and 180 minutes) for each subspecialist location. U.S. Census tract data (ACS) provided female population estimates by race/ethnicity. We defined areas lacking subspecialist access within specified drive-time thresholds and characterized disparities using chi-square tests. RESULTS: Among 901 URPS subspecialists mapped nationally, 84.7% of U.S. women (141.5 million) had access within 60 minutes, while 25.6 million remained outside this threshold. Access improved to 94.1% at 120 minutes (157.3 million women) and 96.2% at 180 minutes (160.8 million). Contrary to typical healthcare disparities, racial minorities showed superior access: Asian women achieved the highest access (95.5%), followed by Black women (90.8%), both significantly exceeding White women (82.7%, p<0.001). Hispanic/Latina access was comparable to that of Whites (83.3%). However, American Indian/Alaska Native women experienced severe disparities, with only 54.3% having 60-minute access—41 percentage points below Asian women (p<0.001). Geographic expansion beyond 60 minutes yielded diminishing returns: extending from 30 to 60 minutes captured 29.6 million additional women, but adding 60 to 120 minutes captured only 15.8 million, and extending from 120 to 180 minutes captured just 3.5 million. North Dakota and Wyoming had zero FPMRS coverage. CONCLUSIONS: This first comprehensive drive-time analysis reveals extreme geographic maldistribution of URPS subspecialists, with a complete absence in two states and severe disparities affecting American Indian/Alaska Native populations. Metropolitan concentration produces the counterintuitive finding that racial minorities achieve superior access to subspecialty pelvic surgery compared to White populations. However, 25.6 million women—disproportionately rural and Native American—lack timely access to complex prolapse surgery, mesh complication management, and advanced reconstructive procedures. The 60-minute threshold represents an optimal planning target, with minimal population gains beyond 120 minutes. Findings support urgent need for targeted interventions: regional hub-and-spoke surgical models, mobile subspecialty clinics in underserved areas, and fellowship incentives for practice in states with zero or minimal URPS coverage.Figure 1
Muffly et al. (Fri,) studied this question.