Urologists are medical practitioners specializing in diseases and conditions of the urinary tract and male reproductive system, including male infertility. The distribution of urologists in the United States is not uniform, with certain states having a higher concentration of urologists than others. States with larger populations such as California, Texas, New York, and Florida tend to have a higher number of urologists due to the increased demand for healthcare services. Metropolitan areas within these states, such as Los Angeles, New York City, and Houston, often have a more significant concentration of urologists.

On the other hand, rural areas and states with smaller populations may face challenges in attracting and retaining urologists. This imbalance in distribution can lead to disparities in access to specialized urological care for individuals residing in remote or underserved regions.

Several factors contribute to the uneven distribution of urologists across the country:

• Population Density can affect urologist distribution, as areas with higher population densities tend to have a greater number of urologists due to increased demand and proximity to medical facilities. Urban centers attract more medical professionals, including urologists, due to the presence of comprehensive healthcare infrastructure, academic institutions, and research opportunities.

• Proximity to medical schools, teaching hospitals, and urology residency programs can significantly impact the distribution of urologists. Urban areas with established medical institutions often provide an environment conducive to urological training and research, leading to higher numbers of practicing urologists.

• Availability of well-equipped medical facilities, including hospitals and clinics, plays a factor in attracting and retaining urologists. Therefore, areas with limited healthcare infrastructure, especially in rural regions, may struggle to provide comprehensive urological care.

• Economic factors such as income opportunities and cost of living can affect urologist distribution. Higher-income regions often have more resources to attract and retain urologists, whereas areas with lower reimbursement rates or limited job opportunities may face difficulties in attracting specialized practitioners.

The uneven distribution of urologists has implications for access to urological care, particularly for individuals living in underserved areas. Patients in rural regions may face longer travel times and increased costs to access specialized urological services. Limited access can result in delayed diagnoses, inadequate follow-up care, and increased healthcare disparities.

Distribution of ART Centers and Male Infertility Specialists

States with the highest number of ART centers are California, New York, and Texas. There were no ART centers in Wyoming, Montana and Alaska. On an overall state level (with the proximity of ART center to male specialist not being considered) the highest number of ART centers served per male specialist was found in Tennessee, followed by Connecticut, Indiana and Kansas. Location of ART centers and male specialists were generally well located in relation to high density of male population in the reproductive years. The top states in the United States with most men in reproductive age are California, New York, Texas, Florida, Illinois, Pennsylvania, Ohio, New Jersey, Michigan, Georgia, Massachusetts, North Carolina, Virginia, Washington, Maryland, Tennessee, Indiana. These states are either having a good supply for ART centres with a good number of urologists specializing in Infertility or at a 60 minute driving distance to a urologist specializing in Infertility.

Leveraging technology, including tele-health and online health platforms and community support services such as Fertiliti can help bridge the gap between patients and urologists in underserved areas, as well as patients who need immediate care or attention. It offers the opportunity to extend urological services to regions with limited access. By working towards a more balanced distribution of urologists, we can ensure that individuals across the country have equitable access to urological care, regardless of their geographic location.

Sources: Garg T. et al, 2022; Cyr M.E. et al, 2019; Odisho A.Y. et al. 2009