This study will describe changes over time in the supply and distribution of specialist physicians in the rural and urban U.S. overall and within six rural/urban categories, as well as within Census Divisions, selecting specialties that provide care for the leading causes of rural mortality: heart disease (cardiology), cancer (oncology and various surgical subspecialties), chronic lower respiratory disease (pulmonology), and stroke (neurology). We will also examine how supply varies according to demographic characteristics of the population, including race/ethnicity and socioeconomic status.

In addition to these quantitative analyses, we will conduct qualitative analyses of interviews with rural health system leaders in more remote communities to understand how rural patients with these conditions access appropriate specialty care. Interviews will focus on uncovering barriers in smaller and more remote rural communities to accessing care, models for providing access to specialists in places that cannot recruit specialists or sustain full-time practices, and threats as well as opportunities for sustaining these services.