Characterizing the geographic distribution of vascular surgeons in the United States.

OBJECTIVE: The shortage of vascular surgeons can be attributed to multiple factors, including an aging population, the increasing demand for vascular surgeons, and an aging vascular surgery workforce. The distribution of vascular surgeons across the United States varies by locale; thus, the shortage affects regions of different sizes disproportionately. We collated the geographic data to characterize the current distribution of vascular surgeons with an emphasis on the practice location, population density, and population age. METHODS: Vascular surgeons were identified using the Physician Compare National Downloadable file from the Centers for Medicare and Medical Services. The counties were matched with each surgeon's practice location. The locations were categorized into metropolitan, urban, or rural using the rural-urban continuum codes. Census Bureau data were used to match all counties with their population-level metrics. The distribution of vascular surgeons was analyzed by comparing the number of counties served, total patient population served, and patient population aged >50 and >65 years served. Finally, the density of vascular surgeons in the United States for the total population and for those aged >50 and >65 years was calculated. RESULTS: In 2018, the U.S. population was 309.8 million, and there were 3145 counties. Of the 3145 counties, 533 (17%) had had a practicing vascular surgeon. The combined population of these counties was 213.8 million people (69% of the U.S. population). Stratified by age, the vascular surgeons in these 533 counties could treat 37.3 million people aged >50 years and 17.4 million people aged >65 years. However, 2612 counties (83%), with a total population of 96 million people (31% of the U.S. population), had had no practicing vascular surgeon. When stratified by age, 78.1 million people in the uncovered counties were aged >50 years and 35 million were aged >65 years. Of the 2612 uncovered counties, 48% were urban and 24% were rural. CONCLUSIONS: We found a nationwide shortage of vascular surgeons, with urban and rural areas disproportionately affected negatively. Although encouraging vascular surgeons to practice in underserved areas would be an ideal solution, it is not pragmatic. Therefore, developing alternatives such as using primary care providers, investing in telehealth and developing transfer systems could be viable methods of providing vascular care to geographically isolated populations. These findings have significant implications for hospitals, patients, and vascular surgeons, who would all stand to benefit from efforts to address these disparities.

Characterizing the Online Presence of Interventional Radiologists: A Potential Marketing Opportunity.

Purpose Patients increasingly utilize online resources to access healthcare information. Over the years, there has been an increasing trend of websites that allow patients to review their physicians. In many instances, the information found on these websites can be inaccurate or obsolete. This can affect patients' ability to make informed decisions about their provider choices. The need for interventional radiologists (IRs) is expected to rise due to an increasing demand for minimally invasive procedures. However, there is a lack of research regarding their online presence. Therefore, this study aims to characterize the online presence of IRs in the United States. Materials The Physicians Compare National Downloadable File (PCNDF) from the Center for Medicare Services was used to identify a sample of IRs in the United States. Then, a Google Custom Search Engine was created to parse the first ten search results for each physician using a set of search parameters. A coded script analyzed the URL contents of each link and placed the search results into one of the following categories: health or hospital system, third-party, social media, academic journal, or other. Results A total of 1,666 IRs were included for analysis. The results are as follows: 26.94% were from hospital or health systems, 66.93% were from third-party websites, 5.48% were from social media sites, 0.02% were from academic journals, and 0.64% were from other. Conclusion The online presence of IRs is primarily controlled by third-party websites, many of which do not allow physicians to manage their content. As the field of interventional radiology continues to grow; a great opportunity exists for physicians to expand their digital presence to more accurately reflect their practice.

Minding the Gap: Clinical Manifestations of a Rare Type IV Hiatal Hernia.

Hiatal hernias are classified according to the increasing severity of protruding intra-abdominal viscera through the esophageal hiatus (types I-IV). Herein is the case of an elderly patient presenting with recent-onset dyspnea, postprandial gastroesophageal reflux, and hypoxemia. Imaging revealed a rare type IV hiatal hernia implicating the stomach and part of the pancreas. This case highlights the seemingly benign clinical manifestations of a massive hiatal hernia, despite its ability to complicate treatment or exacerbate comorbid conditions.

Bedside Diagnostics for Infections: A Guide for Dermatologists.

In dermatology, there are many bedside diagnostic tests that may aid in more rapid diagnosis and early initiation of appropriate therapy. When performed correctly, these bedside diagnostic tests can provide both sensitive and specific results. We discuss bedside diagnostic tests, such as the Tzanck smear, potassium hydroxide (KOH) preparation, and mineral oil preparation, with a specific focus on their use in diagnosing infectious dermatoses.

David Versus Goliath: The Clinical Consequences of an Influenza A Viral Infection in an Unvaccinated Patient.

Acute influenza virus (AIV) infection can manifest as a severe life-threating illness in patients who are not vaccinated, and furthermore, have comorbidities that place them at risk for rapid respiratory decompensation. Each year influenza causes death in individuals with high risk for contracting this infection, although the illness is preventable by vaccination. Complications of AIV infection, such as bacterial pneumonia are treatable, but other severe complications such as acute respiratory distress syndrome (ARDS) leading to diffuse alveolar damage (DAD) are limited to supportive therapy and self-resolution. In most cases, ARDS leading to DAD is fatal, due to the insidious severity of symptoms which lead to rapid oxygen desaturation without correction, and despite supportive therapy. Regardless of a poor prognosis, the clinical signs and symptoms are congruent with imaging and attest to the importance of vaccination, which protect against high mortality rates.