Factors Associated with Receiving Thyroid Cancer Care from High-Volume Surgeons: Analysis of a Statewide Claims Registry

Background: High-volume thyroid surgeons (HVTS) provide quality care with fewer adverse outcomes, yet access to these surgeons can be challenging. This study aimed to assess factors associated with receiving care from a HVTS for thyroid cancer. Study Design: This retrospective cohort study analyzed adults with thyroid cancer who underwent thyroidectomy in a statewide multi-payor claims registry (2015-2022). Surgeons were classified as high- (>25/year) or low-volume (≤25/year; LVTS). Logistic regression evaluated demographics; distance between home, surgical facility, and closest endocrinologist; and zip code-level census data in association with surgery by a HVTS. Results: Overall, 357 surgeons performed thyroidectomies on 3,839 patients with thyroid cancer: 17 (4.8%) were HVTS and 340 (95.2%) were LVTS. Most thyroidectomies were performed by LVTS (53.9%, n=2,068). Patients treated by HVTS travelled an average of 4.8 miles farther to their treating surgeons (33.7±44.4 miles versus 28.9±44.3 miles to LVTS, p<0.001). Factors significantly (p<0.05) associated with an increased likelihood of treatment by a HVTS included: having Medicare Advantage through a preferred provider organization and living further from their treating surgeon. Patients who were significantly (p<0.05) less likely to have surgery by a HVTS were: male, had Medicare insurance without an Advantage plan, lived in a zip code with low educational attainment, and lived further from an endocrinologist. Conclusion: This study identified several factors independently associated with decreased odds of having thyroidectomy by a HVTS for thyroid cancer treatment in the state of Michigan. These results underscore the continued existence of inequities in access within our healthcare system.