Improving access to urologic care for rural populations through outreach clinics.

Objective: To determine the effect of outreach clinics on access to urologic care in a state with a large rural population. This is especially pertinent given the predicted shortage of urologists over the next decade and the trend toward practice in urban area.

Methods: We analyzed provider level data from urologic practices within the state of Iowa using information from 2 publicly available sources: (1) the Office of Statewide (Iowa) Clinical Education Programs, which collects detailed information on visiting consultant urologists (VCU), and (2) the Iowa Physician Information System, which tracks demographic and professional data on all active physicians in Iowa. Factors analyzed included percent of counties and Iowans served by urologists and travel distances/times for patients and physicians.

Results: Currently, 57% of Iowans are within 30 minutes of a urologist's primary office, increasing to 84% with VCU outreach clinics. Fifty-five urologists, including 40 of 69 (58%) of Iowa-based urologists, perform outreach within Iowa, accounting for 198 clinic days and 20,400 miles of travel per month.

Conclusion: Within Iowa, the lack of rural urologists has been mitigated, in part, by an extensive VCU network. However, improved access has required significant effort from urologists in both time and miles traveled. This study is the first to show how a rural state can effectively use physician outreach clinics to provide specialized urologic care to underserved, rural communities.