Reevaluating the Perceived Medical Advantage of New York City

Recent research challenges the long-held belief that New York City’s extensive array of medical specialists confers a clear healthcare advantage. While the city offers nearly all medical specialties, a new study indicates that per capita distribution of these specialists is actually lower compared to smaller cities. This paradox highlights that larger urban centers, often assumed to provide superior specialized care, may in fact have fewer specialists available for each resident, leading to longer wait times and higher patient loads.

Published in Nature Cities and based on data from approximately 1.4 million healthcare providers across 75 medical specialties in 898 metropolitan and micropolitan areas, the study uses advanced urban scaling techniques combined with network science and economic geography. The findings show that 88% of specialties display "sublinear scaling," meaning their per capita availability decreases as city size increases.

Lead researcher Maurizio Porfiri explains that the notion of urban healthcare advantages may primarily apply to primary care services. In contrast, specialized care in large cities is often less accessible than in smaller cities, where residents might have equally or more effective access to specific specialties. For example, smaller cities like Marshfield, Wisconsin, provide more specialists per resident than New York City, despite the latter's reputation for medical excellence.

The study also exposes significant disparities in underrepresented specialties such as addiction medicine, preventive medicine, osteopathic manipulative medicine, and micrographic dermatologic surgery. Addiction medicine shows the most pronounced disparity, with the number of specialists per resident being drastically lower in large cities.

Mechanisms behind this paradox include the higher patient loads overwhelming specialists in urban areas and economic clustering of healthcare services that concentrate expertise in dense hospital networks, creating geographic inequalities. This situation raises concerns, especially as the U.S. population ages and demand for geriatrics and other specialized fields intensifies.

Geographically, the highest densities of specialists tend to cluster in the Midwest, especially Minnesota, while the South shows the lowest access levels. Interestingly, some specialties like anesthesiology, internal medicine, and clinical psychology actually have higher provider-to-resident ratios in large cities, reflecting the diverse urban demand.

This research emphasizes that healthcare distribution in the U.S. is complex, and urban advantages are not uniform across all specialties. Policymakers should consider these nuances when planning for equitable healthcare access as the nation’s demographic and medical needs evolve.

Source: https://medicalxpress.com/news/2025-09-york-city-medical-specialist-advantage.html