Dr. Jesus Ulloa works with PASE towards the goal of identifying barriers that affect access to surgical services and their disproportionate impact upon vulnerable populations. Anticipated barriers that may contribute to delayed disease presentation and disparate outcomes include distribution of sub specialty providers, provider referral networks, and various socioeconomic determinants of health. We have previously identified an association between payer status and use of post acute care facilities among open aneurysm repair and lower extremity bypass patients (PMID 28279729). Patients who were self pay were less likely to be discharged to a post acute care facility which may impact overall recovery and contribute to readmissions.
With regards to workforce composition and distribution of providers, there is a strong literature base identifying predictors of physician practice site. For example, physicians who grew up in a rural setting are more likely to practice in a rural location after completing training (PMID 29181791). We have previously studied individual perceptual and structural barriers for pursuing a surgical specialty amongst practicing surgeons from under-represented in medicine backgrounds (PMID 29742613). Our findings demonstrate a strong need for mentorship in training and the identification of aspirational figures prior to residency to create a more diverse surgical workforce. Our ongoing studies and findings will be used to shape policy for timely access to surgical service when needed for all residents of California.