Public Release: 

Distance to nearest pediatric surgeon a potential barrier for millions of US children

Many families must travel at least 60 miles to access pediatric surgical care, according to research being presented at American Academy of Pediatrics 2018 National Conference & Exhibition

American Academy of Pediatrics


IMAGE: This is a dot distribution map of US Census blocks with distance to closest pediatric surgeon demonstrated by color and population density demonstrated by size. view more 

Credit: Christian McEvoy

ORLANDO, Fla. - Children who need surgery, statistics show, have fewer complications when it's performed by doctors with specialized pediatric surgical training in regionalized centers where a high a volume of procedures are performed. But in ongoing efforts to develop these regional "centers of excellence," researchers presenting new findings at the American Academy of Pediatrics (AAP) 2018 National Conference & Exhibition suggest, the distances families must travel to access pediatric surgical care should be considered.

The study abstract, "Geographic Distance to Pediatric Surgical Care within the Continental United States," will be presented on Saturday, Nov. 3, at the Orange County Convention Center in Orlando, Fla.

As of the last U.S. Census, more than 10 million children lived more than 60 miles from the nearest pediatric surgeon, according to the abstract authors. Another 7 million children lived more than 40 miles from one.

Longer distances can be a concern for some families, said senior author Capt. Robert Ricca MD, FAAP, Pediatric Surgeon and Director of Surgical Services at the Naval Medical Center in Portsmouth, Va,

"Children and families who live significant distances away may face greater risk for treatment delays, as well as added costs from travel, time away from work, and child care for other children at home," Dr. Ricca said. "With ongoing efforts to build and identify centers of excellence for pediatric surgical care, it is also important to consider the distance-to-care as a potential barrier for access to care."

For their analysis, the researchers used 2010 U.S. Decennial Census and American Pediatric Surgical Association membership data to calculate straight-line distances between pediatric surgeons' ZIP codes and population blocks. They said they hope their findings will provide a framework to use publicly available data from the next census in 2020 to guide appropriate regionalization efforts for subspecialty care based on patient location.

"While not necessarily related to our role as military physicians, our practice in pediatric surgery has led us to develop an interest in the effects of regionalization of health care on the distance patients must travel to receive subspecialty care," said Lt. Christian McEvoy, M.D., M.P.H., an abstract author and Health Analysis Fellow and surgical resident with the Naval Medical Center. "Ensuring equal access to pediatric surgical care for all children is a goal in line with regionalization efforts to ensure care is provided at an appropriate center,"

Dr. McEvoy will present an abstract of the study, available below, between 7:15 a.m. and 8:45 a.m. Windermere Ballroom X.

In addition, Dr. McEvoy will be among abstract authors available during an informal Media Meet-and-Greet session Saturday, November 3, from 1 p.m. to 1:45 p.m. EST in room W208AB of the Orange County Convention Center (Press Office).

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal.


The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at

Abstract Title:

Geographic Distance to Pediatric Surgical Care within the Continental United States

Christian McEvoy

Norfolk, VA, United States

Purpose: Geographic proximity is described as a barrier to health care with respect to pediatric surgical care. It has not been evaluated using the Decennial Census nor have racial, ethnic, gender, or urbanization variations been reported. This study's aim is to describe proximity of children living in the continental United States (CONUS) to the nearest pediatric surgeon and to describe racial, ethnic, gender, and urbanization variations. A secondary aim is to describe a low-cost, novel, and relevant analytic method in anticipation of the upcoming 2020 Census. Methods: The 2010 American Pediatric Surgical Association member file and the 2010 Decennial Census were used to calculate straight-line distances between pediatric surgeons' zip code centroids and census block centroids. These same data were used to describe variations across children's races, ethnicities, and genders as well as urban versus rural classification.

Results: In 2010, 716 pediatric surgeons, practicing across 374 distinct locations, were identified. The number of populated Census blocks identified was 6,182,882. Table I describes the 73,690,271 children enumerated in the 2010 Census and variations across distances-to-care. The ratio of children to pediatric surgeons was 102,919:1. Of non-white Hispanic children, 30.1% lived greater than 40 miles from care. Of Native American children, 40.5% lived more than 60 miles from care. Among children 0-5 years of age, the median (IQR) miles to closest pediatric surgeon was 14.2 (6.2, 39.6), and 3,010,698 of these children lived more than 60 miles from care. Conclusion: More than 10 million children lived greater than 60 miles from the closest pediatric surgeon in 2010. Racial, ethnic, age, and urbanization disparities in proximity to pediatric surgeons were present in the United States in 2010. This method is feasible to describe distance-to- care with the upcoming 2020 Decennial Census and may benefit future allocation of pediatric surgeons.

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