New York City's medical specialist advantage may be an illusion, new NYU Tandon research shows

(Press-News.org) New York City offers nearly every type of medical specialist but provides fewer specialty healthcare providers per capita than smaller cities, according to a new study that challenges conventional assumptions about urban healthcare advantages and reveals a troubling paradox across America's largest metropolitan areas.

The research, published in Nature Cities, analyzed data from 1.4 million healthcare providers across 75 medical specialties in 898 metropolitan and micropolitan areas. The innovative approach combines urban scaling theory—which examines how city characteristics change with population size—with network science and economic geography to examine healthcare access in unprecedented detail.

Rather than treating healthcare as a single entity, the researchers examined each medical specialty separately, revealing that 88% exhibit what they call "sublinear scaling," meaning larger cities have proportionally fewer specialists per resident than smaller ones.

"We're discovering that the healthcare advantages of living in big cities may be an illusion when it comes to specialized care," explains lead researcher Maurizio Porfiri. "We all assume residents of large metropolitan areas have better access to healthcare than residents of smaller cities, but this is really true only for primary care services. Our findings suggest this assumption breaks down completely for medical specialists. A small city may not offer all the specialties of large cities, but in what it offers it may outperform them.”

Porfiri is an NYU Tandon Institute Professor with appointments in the Departments of Mechanical and Aerospace Engineering (MAE), Biomedical Engineering (BME), Civil and Urban Engineering (CUE), and Technology Management and Innovation (TMI). He also serves as Director of the NYU Center for Urban Science + Progress (CUSP).

The study represents the latest application of Porfiri's urban scaling methodology, which he has previously used to analyze gun violence patterns and the relationship between city living, ADHD and obesity. His research uses Scale-Adjusted Metropolitan Indicators (SAMIs) to control for population differences and reveal how cities deviate from expected patterns.

The study found that while cities like New York and Chicago offer nearly all examined specialties (NYC has 74 — missing only anesthesiology assistants — and Chicago has all 75), residents may face longer wait times and specialists higher patient loading.

In contrast, smaller cities may lack certain specialties entirely—73 of the 75 specialties showed significant associations between availability and population size—but those that exist serve fewer patients per provider. For example, Marshfield, Wisconsin provides 16.8 specialists per 1,000 residents compared to New York's 4.7 per 1,000.

Among the most underrepresented specialties in large cities per capita are addiction medicine, preventive medicine, osteopathic manipulative medicine, and micrographic dermatologic surgery.

Addiction medicine shows the starkest disparity, with large cities providing dramatically fewer specialists per resident than smaller areas. These fields showed the strongest sublinear scaling, meaning residents of major metropolitan areas have significantly fewer of these specialists available relative to their population size compared to smaller cities.

The research identifies two mechanisms driving this paradox: higher patient loads overwhelming specialists in large cities, and economic clustering that concentrates medical expertise in dense hospital networks, creating geographic inequalities.

“The findings have serious implications as the U.S. population ages. The study found sublinear scaling in geriatric specialties like urology and gerontology, suggesting major metropolitan areas may be unprepared for growing elderly populations,” said Tian Gan, a NYU Tandon mechanical engineering PhD student in the urban science track, and the paper’s lead author.

Geographic patterns reveal stark regional disparities. The highest specialist concentrations cluster in the Midwest—Minnesota alone claims two of the top five cities—while all five cities with the lowest access are in the South.

Not all specialties follow this pattern. Several key specialties—including anesthesiology, internal medicine, and clinical psychology—actually have more providers per capita in large cities, reflecting higher urban demand for these services.

The research provides a framework for understanding healthcare distribution that moves beyond the traditional urban-rural dichotomy. Rather than viewing cities as uniformly advantaged, policymakers must consider the complex interplay between diversity and provision of medical services.

Along with Porfiri and Gan, the paper's additional author is Tanisha Dighe, NYU Tandon MS student in applied urban science and information. The study was supported by National Science Foundation grants.

APPENDIX: Medical Specialist Availability by City

CITIES WITH THE MOST MEDICAL SPECIALISTS (Cities offering all specialty types)

Chicago-Naperville-Elgin, IL-IN: 75 specialties Houstone-Pasadena-The Woodlands, TX: 75 specialties Atlanta-Sandy Springs-Roswell, GA: 75 specialties Washington-Arlington-Alexandria, DC-VA-MD-WV: 75 specialties Miami-Fort Lauderdale-West Palm Beach, FL: 75 specialties CITIES WITH THE FEWEST MEDICAL SPECIALISTS (Fewest specialty types available)

Monroe, LA: 5 specialties Zapata, TX: 6 specialties Raymondville, TX: 6 specialties Synder, TX: 11 specialties Andrews, TX: 11 specialties CITIES WITH THE HIGHEST CONCENTRATION OF SPECIALISTS OVERALL (All non-primary-care specialists combined per 1,000 residents)

Rochester, Minnesota: 21.1 specialists (home to Mayo Clinic) Marshfield, Wisconsin: 16.8 specialists Sunbury, Pennsylvania: 16.3 specialists Easton, Maryland: 15.7 specialists Albert Lea, Minnesota: 15.4 specialists CITIES WITH THE LOWEST CONCENTRATION OF SPECIALISTS OVERALL (Fewest specialists per 1,000 residents)

Monroe, Louisiana: 0.1 specialists Virginia Beach-Norfolk, Virginia: 0.4 specialists Danville, Virginia: 0.8 specialists Rio Grande City-Roma, Texas: 1.0 specialists Bonham, Texas: 1.0 specialists SPECIALTIES MOST UNDERREPRESENTED IN MAJOR METROS, 1M+ POPULATION

(Scaling exponents - how fast they grow with population growth )

Addiction Medicine (0.305) - Most underrepresented Preventive Medicine (0.331) Osteopathic Manipulative Medicine (0.351) Micrographic Dermatologic Surgery (0.379) Maxillofacial Surgery (0.398) Marriage and Family Therapist (0.400) Nuclear Medicine (0.408) Advanced Heart Failure and Transplant Cardiology (0.446) Certified Clinical Nurse Specialist (0.457) Sleep Medicine (0.457) SPECIALTIES MOST OVERREPRESENTED IN MAJOR METROS

(Scaling exponents - - how fast they grow with population growth)

Anesthesiology (1.154) - Most overrepresented Internal Medicine (1.100) Physical Therapy (1.089) Clinical Psychology (1.069) Physician Assistant (1.057) Obstetrics/Gynecology (1.050) Neurology (1.039) Psychiatry (1.031) Gastroenterology (1.022) NYC SPECIALIST COUNTS (74 out of 75 research specialties)

Missing only: Anesthesiology Assistant

Top 10:

Nurse Practitioner: 8,977 Internal Medicine: 8,194 Physical Therapy: 7,515 Physician Assistant: 6,224 Clinical Social Worker: 4,842 Anesthesiology: 3,637 Family Practice: 3,259 Diagnostic Radiology: 2,843 Emergency Medicine: 2,545 Psychiatry: 2,465 Notable underrepresented specialties (bottom 5):

Maxillofacial Surgery: 40 Micrographic Dermatologic Surgery: 25 Preventive Medicine: 21 Marriage and Family Therapist: 18 Addiction Medicine: 16 END