Key takeaways:
GoodRx Research finds that nearly 5.5 million Americans live in a pulmonology desert: a county in which more than half of the residents live at least an hour away from lung care.
We also identified many counties that are pulmonology deserts and have a high number of residents who suffer from COVID-19 and lung conditions like chronic obstructive pulmonary disease (COPD) and asthma.
Nevada, Montana, and much of the central U.S. have a high concentration of pulmonology deserts.
Nearly 5.5 million people in the U.S. lack adequate access to lung care, according to new research from GoodRx. These people, who live in “pulmonology deserts,” have to drive at least an hour to get to the closest pulmonologist.
Access to a pulmonologist is essential, especially for those living with persistent lung conditions like asthma or chronic obstructive pulmonary disease (COPD). Pulmonologists specialize in diagnosing and treating diseases affecting the respiratory system. Some of these diseases can be caused by infection, inflammation, or tissue overgrowth and require long-term or lifelong treatment.
Many pulmonologists have recently noted an influx of patients, and some practices have become overwhelmed. This, coupled with new variants of COVID-19 and rising rates of long COVID, make access to lung care more important than ever.
Over 16 million Americans have COPD, which is a major cause of death in the U.S. The extent of these conditions led the U.S. Department of Health and Human Services’ Office of Disease Prevention and Health Promotion to list respiratory disease as an objective for their Healthy People 2030 initiative. Healthy People’s goal is to increase the prevention, detection, and treatment of respiratory diseases.
To identify areas that lack proper pulmonary care, the GoodRx Research team mapped 8,398 locations where pulmonologists practice across the country. Many locations such as hospitals and specialty clinics have more than one pulmonologist practicing at the same location.
We then identified counties with a majority of the population living at least an hour from the closest pulmonologist.
Similar analyses have also used the 1-hour threshold. That’s because this drive time could affect a patient’s ability to seek care. They may struggle to find transportation, afford the cost of transportation, or take time off work.
We uncovered 488 desert counties in total, accounting for over 5 million Americans. The counties are called out in blue on the map below.
Even though there are over 15,000 practicing pulmonologists spread throughout the U.S., these providers are dispersed unevenly.
The majority of those living in a pulmonology desert county will need to drive 1 hour or more to see a pulmonologist. But our research found that drive time can vary significantly by county. For instance, the 41,000 residents in Williams County, North Dakota, must drive over 3 ½ hours to the nearest pulmonologist. Aleutians West Census Area, in Alaska, is an extreme case. There, the closest pulmonologist to the 4,200 residents is 2 days 17 hours away.
On top of this, a clear pattern emerges in the map above: A significant number of pulmonology deserts are in the central U.S. Specifically, North and South Dakota, Nebraska, and Kansas contain multiple deserts. And nearly all counties in Montana and Nevada are pulmonology deserts.
So what is to blame? It is possible that these states have more rural areas, which may lack hospitals or primary care providers altogether.
Another reason could be a general lack of pulmonologists across the U.S. Although pulmonary critical care fellowship positions have increased over the past decade, pulmonary care positions have remained the same.
What’s more, fewer pulmonary residency positions are being offered annually, with only 25 positions and only 13 programs available in 2022 compared to pulmonary critical care, which offered 721 positions in 2022.
We included both pulmonary and pulmonary critical care physicians in our analysis. However, pulmonary critical care physicians are trained to not only treat pulmonary patients, but patients in the intensive care unit (ICU) as well. So those who only practice pulmonary care are key to filling the gap for pulmonary patient care when there aren’t enough pulmonary critical care physicians available.
While it may be easy to write off many of these deserts as rural counties that may not readily need access to lung care, our research suggests otherwise. Below we walk through asthma, COPD, and COVID-19 rates in these places to show just how important access to pulmonology care is, even in the most rural of states.
The GoodRx Research team pinpointed areas with high lung disease rates to understand which counties had the highest need for additional pulmonary care. We specifically looked at the rates of COPD, asthma, and COVID-19.
The map below depicts the 488 pulmonology desert counties and how prevalent asthma, COPD, and COVID-19 are in each. We considered a county to have high prevalence if its disease rate was greater than 75% of all other counties in the U.S.
Below, counties highlighted in dark blue need access to care the most. In these counties, lung conditions are more common than the U.S. average, and residents must drive over an hour to access care.
Unlike the first map above, there seems to be no clear pattern. Rather, pulmonology desert counties with high COPD, asthma, or COVID-19 rates seem to be dispersed throughout the U.S.
To take one example: Oglala Lakota County, South Dakota, has a higher rate of COPD and asthma than 75% of all other counties in the U.S. In that county, 12.5% of residents have COPD and 13.8% have asthma. On top of that, they will need to drive an hour and a half, on average, to access lung care.
These residents will be faced with a difficult decision: commute hours to a provider or forgo care. This decision can become even more difficult for those without a car, or those who may lack the ability to take time off of work to travel.
Residents in Roosevelt County, Montana face a similar decision. Here, 12.1% and 9.5% of the population have asthma and COPD, respectively. But for these residents, it will take nearly 4 ½ hours to reach the closest pulmonologist.
Both counties also have a majority American Indian and Alaska Native (Non-Hispanic) population and are an underserved group in the U.S. Recent studies have shown that this community has higher asthma and COPD rates than the white Non-Hispanic population due to socioeconomic challenges. So improving access to care for underserved populations in these areas is even more critical.
Additionally, almost all counties in Nevada are highlighted in blue, indicating they are all pulmonology deserts with higher-than-average COPD and asthma rates. Most residents will have to drive farther than an hour to seek care for their lung condition.
As COVID-19 spreads, those with previously healthy lungs may need access to a pulmonologist due to long COVID. Currently, it is estimated that as many as 23 million Americans have been affected by long COVID. It can cause fatigue, shortness of breath, and brain fog, among other symptoms.
With that in mind, the GoodRx Research Team also identified counties that have had high COVID-19 rates. Our goal was to find counties that may require additional pulmonology care due to high rates of COVID, which in many cases can lead to long COVID.
Counties shaded in dark blue below have had high average COVID-19 case rates over the course of the pandemic and lack access to lung care.
Rolette County, North Dakota has high rates of all three lung conditions (COPD, asthma, and COVID-19) and is also a pulmonology desert. Native Americans make up 78% of the population there, specifically the Turtle Mountain Band of the Chippewa Indian Reservation. They have limited taxable land, which leaves those living there in high need with little resources. Over 30% of the population in Rolette County live below the poverty level, which is a major barrier to accessing care and transportation to care.
On a positive note, the county’s public health district was able to launch a mobile health clinic on wheels with federal COVID-19 funds.
But while several counties in North Dakota are in similar situations, three of the top five pulmonology desert counties with the highest COVID-19 case rates are in Texas. Only 20% of Loving County’s residents are vaccinated even though only 64 people live there. As shown in our map, several southern border counties in Texas have high COVID-19 rates and are pulmonology deserts.
Since the beginning of the COVID-19 pandemic, those living in these counties have experienced higher infection and death rates. Several factors are at play, from fear of deportation to lack of Medicare expansion and insurance coverage. All of these will affect how and if a sick person seeks care. The high infection rates in these areas increase the likelihood of long COVID cases.
Not being able to reach pulmonary care because of distance, on top of these other barriers, could be extremely detrimental to the populations in these counties.
Large swathes of the country don’t have reasonable access to lung care. And many of the residents in these areas are dealing with lung conditions that require treatment.
So what do people who live in pulmonology deserts do if they need to seek a specialist's care? Telehealth is an option for those who have Internet access and a computer. According to a survey from the American Medical Association, over 80% of providers used telehealth in 2021, and 80% believed patients improved their access to care through telehealth.
What’s more, if a pulmonologist seen through telehealth recommends respiratory therapy to help manage and improve a patient’s lung condition, the patient may have more options than if they need treatment from a pulmonologist. There are over 130,000 respiratory therapists in the U.S., far outpacing the 15,000 pulmonologists in the U.S.
Going forward, better availability of lung treatment shouldn’t be overlooked — especially in light of the ongoing pandemic.
Co-contributors: Diane Li, Tori Marsh, MPH
The dataset on healthcare providers is licensed through HealthLink Dimensions. Based in Atlanta, HealthLink Dimensions is the authority in healthcare provider data, serving hospitals, life sciences, and health insurers with innovative managed data services and enterprise engagement solutions.
Providers were included if they (1) were a doctor of medicine (MD) or doctor of osteopathic medicine (DO); (2) had either ‘‘pulmonologist,” “pulmonary disease,” “pediatric pulmonology,” or “pediatric pulmonary” in their specialty description; (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. A provider may have more than one specialty and/or more than one active location. One identified address was invalid and dropped from our analysis.
The total count of practicing, licensed pulmonology providers may be higher than the number of providers we mapped.
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 pulmonologist. We determined tract population based on the U.S. Census Bureau 2020 Center of Population report, and 566 tracts with a population of 0 were excluded from the analysis. All location metrics (distance and drive times) were computed using the Google Distance Matrix API based on 8,398 distinct accurate locations found for 15,158 pulmonology providers under average traffic conditions. Fifty-six tracts (often due to geographical constraints) had no valid closest driving distance to a pulmonologist — these tracts were also excluded. In total, we used 83,792 out of 84,414 total U.S. tracts and a respective 3,128 out of 3,143 total U.S. counties for our final desert analysis.
We reported the percent of a county population living in a pulmonology desert as a weighted average using tract population living at least 1-hour driving distance away from the nearest pulmonologist. A majority desert county is a county with over 50% of its population living in a desert.
Our estimates for drive times and desert counties are likely conservative. It's probable that people will have to drive farther than we have estimated. We only mapped a tract to the closest provider, but it’s likely patients may run into issues that would cause them to need to drive to a provider even farther away. For example, their closest provider may not take their insurance coverage, may not have appointment availability due to a high caseload, or lack medical infrastructure only found in hospitals that the patient needs.
Disease prevalences are shown based on data from the 2021 CDC PLACES report, which are model-based county-level estimates for (1) age-adjusted prevalence of current asthma among adults aged >=18 years, 2019 and (2) age-adjusted prevalence of chronic obstructive pulmonary disease among adults aged >=18 years, 2019. Prevalence information is unknown and not shown for one majority desert county: Chugach Census Area, Alaska (FIPS 02063).
COVID-19 cases per 100,000 all-time are shown for majority desert counties. We computed COVID-19 cases per 100,000 all-time by averaging 7-day trailing averages for each county over the entire course of the pandemic based on data published by The New York Times. Four desert counties are not depicted in this chart due to missing data: Chugach Census Area, Alaska (FIPS 02063), Yakutat, Alaska (FIPS 02282), Prowers, Colorado (FIPS 08099), and Wallace, Kansas (FIPS 20199).
American Medical Association. (2022). 2021 telehealth survey report.
Bull-Otterson, L., et al. (2022). Post–COVID conditions among adult COVID-19 survivors aged 18–64 and≥ 65 Years—United States, March 2020–November 2021. Morbidity and Mortality Weekly Report.
Center for Disease Control and Prevention. (2021). Places: local data for better health.
Data USA. (2022). Oglala Lakota County, SD.
Data USA. (2022). Roosevelt County, MN.
Healthlink Dimensions. (2022). Homepage.
Kladzyk R., et al.(2021). In Texas-Mexico border towns, COVID-19 has had an unconscionably high death toll. Time.
Laffey, K. G., et al. (2021). Chronic respiratory disease disparity between American Indian/Alaska native and white populations, 2011-2018. BMC Public Health.
Miller, K.T., et al. (2019). Rolette county community health profile. North Dakota Department of Health.
Pawlowski, A. (2021). How to boost lung health and breathe better: Tips from a pulmonologist. Today.
Pierce, J. (2021). Rolette county public health district rolls across the county. Center for Rural Health at the University of North Dakota School of Medicine & Health Sciences.
Richards, J. B., et al. (2020). Characteristics of pulmonary critical care medicine and pulmonary medicine applicants and fellowships. ATS scholar.
Southern Border Communities Coalition. (2021). How covid-19 has impacted the southern border region.
The New York Times. (2021). Coronavirus (Covid-19) data in the United States.
The New York Times. (2022). Tracking coronavirus in Texas: latest map and case count.
U.S. Bureau of Labor Statistics. (2022). Occupational employment and wages, May 2021 29-1126 respiratory therapists.
U.S. Census Bureau. (2020). Center of population report.
U.S. Census Bureau. (2020). Centers of population.
U.S. Department of Health and Human Services. (2022). Healthy people 2030 framework.
U.S. Department of Health and Human Services. (2022). Respiratory disease.
U.S. Government Accountability Office. (2022). Long COVID.
Wei, Y. (2013). How long and how far do adults travel and will adults travel for primary care? Washington State Office of Financial Management.