Healthcare Inequality: The Prevalence of Specialists in Affluent Areas
- Alexia Seymour
- 3 days ago
- 3 min read
It’s no surprise that the U.S. is undergoing a physician shortage. Every day, people who need
some form of physician care are unable to receive it and end up being “neglected” by the
healthcare system. More specifically, people with concerns that can only be resolved by
specialists are often overlooked. Specialists, like dermatologists, ophthalmologists, family
medicine physicians, and many others, cater to specific and not general needs of patients.
Since specialists cater to the specific medical needs of patients, why do so many people
nationwide not receive this specific care? To put it simply, this phenomenon is due to a higher
population of specialists in wealthy, affluent areas in comparison to lower-income areas. From
the years 2012 to 2017, it was revealed that nationwide, 28% of total dermatologists worked in
zip codes in the 0-19th quintile based on poverty level, these being the richest zip codes in the
U.S. [1]. On the other hand, only 18% worked in the poorest zip codes, that being the 80-99th
quintile.
So why do specialists choose to work and set up their practices in considerably wealthier areas?
Firstly, on average, 78.3% of Americans with a family income of $75,000 or more choose private health insurance over public health insurance [2]. Due to this, specialists are paid higher rates
from private insurance companies, as opposed to governmental programs like Medicare or
Medicaid, and that’s a main reason as to why they place themselves in affluent zip codes.
Considering this, it seems like specialists are more concerned with earning more than helping
patients who need the insight of a specialist.
However, it’s important to consider that specialists provide care that the majority of general
physicians can’t, where it’s been found that if patients with heart failure see a cardiologist (a
specialist), the 36% one-year mortality risk decreases substantially [3]. From this, it’s apparent
that specialists are not solely focused on earning a higher salary but want to help patients in need.
Although they tend to treat more patients on average who use private insurance, specialists are
not limited to patients in this group. A generalization of physicians is counterproductive, even
though evidence exists showing that specialists and other physicians tend to cater to wealthier
patients.
That being said, different hospital systems nationwide are making an effort to make specialists
more accessible to lower-income communities. A very familiar hospital system, the Duke Health
system, is now offering “Duke Signature Care” in areas across South Durham. Through this
program, people sign up for a low-cost membership where they can receive referrals to any Duke
Health specialist when needed [4]. This initiative is actively defying the notion that specialists
only cater to wealthier areas and patients, although Duke Health is one of the only systems
offering a service like this.
The large number of medical specialists in wealthy areas contributes to the overall healthcare
access disparities that exist across rural and urban parts of the U.S. Since the majority of affluent
zip codes are located near major urban areas, rural patients are often left in the dust when it
comes to access to medical specialists. Evidence has shown that in rural areas, the number of
specialists per 100,000 people is 30 (rural) to 263 (urban) [5]. As a result of this, rural patients
often don’t receive the medical care they need. To put it simply, the shortage of medical
specialists across lower-income zip codes and rural areas in the U.S. is concerning. Patients in
these areas deserve the same level of care that their wealthier counterparts receive, and action
should be taken to resolve this level of healthcare inequality.
Reviewed by: Anjali Reddy
Designed by: Poorva Chandramouli
References:
[1] Benlangha, I., et al. (2021). Changes in dermatology practice characteristics in the United
States from 2012 to 2017. JAAD International, 3, 92-101. https://www.jaadinternational.org/article/S2666-3287(21)00019-5/fulltext
[2] State Health Compare. (2025). SHADAC analysis of health insurance coverage type by
family income. SHADAC, University of Minnesota. https://statehealthcompare.shadac.org/table/16/health-insurance-coverage-type-by-family-income
#1/5,4,1,10,86,9,8,6,26,27,28,29/76/31,32
[3] Doyle, J. J. (2020). Physician Characteristics and Patient Survival: Evidence from Physician
Availability. NBER Working Paper 27458. https://doi.org/10.3386/w27458.
[4] (2025). Duke Signature Care. DukeHealth.
[5] National Rural Health Association. About rural health care.