Endocrinologist Deserts: A Critical Healthcare Gap for Millions in the U.S.
Key takeaways:
Nearly 70% of U.S. counties lack an endocrinologist (endocrinologist deserts). That means 50 million Americans don’t have access to specialists for critical conditions like diabetes, thyroid disorders, and more.
People in endocrinologist deserts are 12% more likely to die from endocrine-related conditions. They have higher rates of diabetes, obesity, and stroke compared to counties with specialists.
The gaps in endocrinology care span both rural and urban communities.
A staggering two-thirds of U.S. counties don’t have any practicing endocrinologists. In these “endocrinologist deserts,” 50 million Americans struggle to get specialized care for conditions like diabetes, thyroid disorders, and obesity.
Endocrinology is a branch of medicine that focuses on hormones and the glands that produce them. Endocrinologists diagnose and treat complex health conditions, including diabetes, thyroid disorders, osteoporosis, and problems with the adrenal or pituitary glands.
Endocrinologists can also prescribe GLP-1 medications for weight loss and provide care for menopause.
Endocrinologists play a key role in managing these conditions. But many parts of the country — particularly rural and underserved areas — don’t have access to their care.
Nearly 70% of counties don’t have an endocrinologist
The map below reveals the scope of endocrinologist deserts (2,168 counties and nearly 70% of all counties). The affected areas stretch from the Midwest to the South.
In these regions, patients may face delayed care or diagnoses, difficulty managing chronic conditions, and/or more complications.
Counties without specialists have more endocrine-related conditions and deaths
The numbers reveal the disparities between counties with and without endocrinologists.
Counties lacking endocrinologists have an age-adjusted death rate from endocrine, nutritional, and metabolic diseases of 39.0 per 100,000. The rate is 34.7 per 100,000 in counties with specialists. It’s a gap that translates to more lives lost in underserved areas.
Put simply, people in counties without specialists are about 12% more likely to die from these conditions.
We see a similar trend for adult obesity and diabetes. The obesity rate is 38.8% in counties without an endocrinologist and 36% in counties with an endocrinologist.
These figures demonstrate that the absence of endocrinologists isn’t just a gap in care. It results in significantly poorer health outcomes and increased risk of life-threatening complications. This is particularly true for vulnerable populations already grappling with limited healthcare resources.
County-to-county comparisons
The impact of endocrinologist shortages becomes even starker when we analyze counties head to head. The pattern of disparities holds true across rural and urban areas.
East Carroll Parish, Louisiana is a rural endocrinologist desert. The diabetes rate there is 20.4%, and the obesity rate is 51.3%. Bell County, Kentucky is another rural area but with an endocrinologist. Its rates are notably lower, at 14.3% for diabetes and 44.2% for obesity.
A similar gap appears in urban areas. Greene County, Alabama is an urban endocrinologist desert. Its diabetes and obesity rates are 19.4% and 51.0%, respectively. These rates are lower in Cameron County, Texas (19.9% and 47.6%, respectively), an urban area with an endocrinologist.
Stroke rates tell a similar story. Buffalo County, South Dakota is a rural endocrinologist desert. Its stroke rate is 6.7%, far above the 4.5% seen in Thurston County, Nebraska, a rural county with an endocrinologist.
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Diabetes-related deaths further underscore the disparity. Buffalo County reports a diabetes death rate of 143.3 per 100,000. That’s more than double the rate of 56.6 per 100,000 in Bell County, Kentucky, which has endocrinologists.
In urban areas, the pattern holds. Lowndes County, Alabama, an endocrinologist desert, has a diabetes death rate of 66.2 per 100,000. Compare that to just 42.0 per 100,000 in Cameron County.
Across both rural and urban communities, endocrinologist deserts consistently lead to worse health outcomes. These areas have higher rates of a number of conditions, from diabetes and obesity to higher stroke rates and deaths. These disparities make clear the urgency of addressing gaps in specialist access.
Many endocrinologist deserts are healthcare shortage areas
Counties without endocrinologists are often classified as federally designated healthcare shortage areas. These areas have limited access to primary care physicians.
The lack of specialized and general care worsens the challenges these residents face. Many are left with inadequate options for managing their health.
What’s more, the overlap between endocrinologist deserts and healthcare shortage areas adds to the burden on already strained healthcare systems. Without enough primary care access, many patients may not even receive a diagnosis for endocrine-related conditions, let alone the specialized care they need.
This lack of access creates a cascade effect: Preventable conditions like diabetes spiral into severe complications, and communities face rising rates of disability and death.
Summing it all up
Residents of endocrinologist deserts have significantly higher rates of obesity, diabetes, and related complications. They also have higher death rates from endocrine-related conditions.
Without adequate access to care, millions of Americans are left to manage these complex conditions on their own, often with severe consequences.
Expanding access to endocrinology care is essential to bridge this healthcare gap. And doing so could save countless lives. This effort demands innovative solutions, such as:
Creating telemedicine programs to overcome geographic barriers
Providing incentives for specialists to practice in underserved areas
Making broader investments in rural healthcare infrastructure
These solutions could potentially break the cycle of poor health outcomes in endocrinologist deserts. We could ensure all Americans have a fair chance at managing and overcoming preventable, life-altering diseases, especially in rural America.
References
Health Resources and Services Administration (2023). What is a shortage designation?
Methodology
HealthLink professional data and analysis: We licensed the dataset on healthcare professionals through HealthLink Dimensions. Based in Atlanta, HealthLink Dimensions is the authority in healthcare professional data, serving hospitals, life sciences, and health insurers with innovative managed data services and enterprise engagement solutions. Data is current as of October 2024.
We included professionals if they (1) were a doctor of medicine or doctor of osteopathic medicine ; (2) had any of the following listed in their specialty description: reproductive endocrinology, endocrinology, and pediatric endocrinology; (3) were located in one of the 50 U.S. states or the District of Columbia; and (4) had an accurate location mapped to them.
We mapped professionals to the 2020 U.S. Census county via the 2020 Census tract. A professional may have more than one specialty and/or more than one active location. We used unique professional counts to estimate the total number of endocrinologists per county. The total count of practicing, licensed endocrinologist professionals may be higher than the number of professionals we mapped. And there may be discrepancies between Healthlink professional data and professionals listed using online tools such as Google Maps.
Driving distance and drive time estimates: We defined driving distance and drive time for each Census tract as driving distance and drive time between a tract’s center of population to the nearest three endocrinologists. We calculated the distances between the Census Tract Center of Population (2020) to the nearest three endocrinologists using straight-line (Euclidean) distance. All location metrics (distance and drive times) were computed using the Google Distance Matrix API. Our driving estimates are likely conservative since it is possible that people may need to drive farther if the nearest professional has no availability or does not accept their insurance plan. The driving estimates were rolled up to the county level by taking the average of driving distance and drive time across all tracts in a county.
Data sources: We used the 2024 CDC Places data to obtain population and age-adjusted prevalence estimates for binge drinking, obesity, diagnosed diabetes, coronary heart disease, high cholesterol (among those who have ever been screened), vision disability, stroke, lack of leisure-time physical activity, current cigarette smoking, and high blood pressure among adults.
We used the 2024 county health rankings data to obtain estimates for the following indicators: % non-Hispanic Black, % non-Hispanic white, % American Indian or Alaska Native, % Asian, % Native Hawaiian or Other Pacific Islander, % Hispanic, % rural, % 65 and older, % uninsured, primary care physicians, ratio of population to primary care physicians, other primary care providers, ratio of population to other primary care providers, preventable hospital stays, % access to exercise opportunities, life expectancy, limited access to healthy foods, % physical inactivity, and median household income.
We used the latest available data from 2021 in the CDC Vision and Eye Health Surveillance System to obtain county-level estimates for the adjusted percentage of the U.S. resident population with any form of diabetic retinopathy (DR) or vision-threatening DR. This data includes prevalence estimates across all DR stages for all available U.S. locations, offering a comprehensive view of adjusted prevalence rates for diabetic retinopathy at the county level.
We used the latest Health Resources & Services Administration Health Professional Shortage Area (HPSA) to obtain county-level information on healthcare resource availability and need. This dataset includes details on state, county, county Federal Information Processing Standards (FIPS) code, rural status, HPSA score category, poverty rate, HPSA score, HPSA full-time equivalent positions, professional ratio goals, estimated served and underserved populations, shortage amounts, and formal professional-to-population ratios. These metrics provide a comprehensive overview of healthcare access and shortages across U.S. counties.
We used the USDA 2023 Rural-Urban Continuum Codes to classify urbanicity as urban (RUCC codes 1-3), suburban (RUCC codes 4-6), or rural (RUCC codes 7-9). For Connecticut, we used the 2013 Rural-Urban Continuum Codes to maintain consistency with the existing county FIPS codes in the dataset.
Data aggregation and statistical analysis: We aggregated data at the county level using the 2020 county FIPS code to ensure consistent county identification across Census, CDC, and HRSA datasets. We used ANOVA to compare counties based on urbanicity (urban, suburban, rural), followed by Tukey HSD post hoc tests, and performed independent t-tests to assess differences between counties with and without an endocrinologist. We used Python throughout the data processing and analysis.
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