Episode 225: Why Your ZIP Code Can Determine Your Health

Dr. Arreaza: Hello, everyone, my name is Dr. Hector Arreaza, I am a family physician and an associate program director in the Clinica Sierra Vista – Rio Bravo Family Medicine Residency Program.  Today we’re discussing one of the most powerful predictors of health that many people rarely think about: geography. Where someone lives can influence everything from access to physicians and emergency care to chronic disease outcomes and life expectancy. Joining us today is Peyton, who will be taking a deeper look into the matter. Peyton, thank you for being here — can you start by introducing yourself, please? Peyton: Hello, thank you for having me. My name is Peyton, I am a 4th year medical student with Western Atlantic University, and I am from a very small town in South Dakota.  Dr. Arreaza: Peyton, you are on your last few days in your FM rotation, when are you graduation?  Peyton, you prepared this topic and it is great. When people hear the phrase “your ZIP code can determine your health,” what does that actually mean? Peyton: It basically means that where someone lives can significantly influence their health outcomes and even life expectancy. A person’s ZIP code can affect access to physicians, hospitals, transportation, emergency services, and preventative care. Arreaza: Talking about prevention. The American Heart Association agrees with you because Zip code is not part of the cardiovascular risk calculator called PREVENT. I invite everyone to take a look at this new calculator. I think a lot of people assume healthcare is equal as long as hospitals or clinics exist nearby, right? Peyton: Yes, patients may still struggle with overcrowded healthcare systems, which can lead to long wait times. In fact, a national physician appointment survey found that average wait times for new patient primary care appointments in major cities can exceed three weeks, with some cities reporting significantly longer delays depending on specialty access and provider availability. Dr. Arreaza: And when patients experience those kinds of delays, they may frequently switch between providers, which becomes much harder to establish consistent long-term care. Peyton: One of the biggest issues many patients face is continuity of care — having consistent follow-up with the same provider over time. Dr. Arreaza: And that continuity really matters in medicine, especially family medicine, it is one of our keywords: continuity of care. Peyton: Exactly. Preventative care and chronic disease management work best when patients have long-term relationships with healthcare providers. But in many underserved communities, patients may wait months for appointments, frequently change providers, or rely on emergency rooms instead of primary care clinics. Dr. Arreaza: And urgent care too. When care becomes fragmented, conditions like hypertension, diabetes, and chronic illnesses can become much harder to manage. Peyton: Exactly. Delayed screenings, missed follow-up appointments, and lack of preventative care often lead to patients presenting later with more advanced disease that could have been treated earlier. Dr. Arreaza: And urban communities may face some of the same challenges, but rural communities are at a different level of barriers to health care. Peyton: Absolutely. Rural communities often experience significant physician shortages. According to the Health Resources and Services Administration, over 100 million Americans live in primary care shortage areas, and nearly 65% of those shortage areas are located in rural regions. Peyton: I think one of the biggest solutions starts with strengthening primary care and investing more heavily in underserved communities, especially rural areas. Dr. Arreaza: And that includes increasing the number of physicians going into family medicine and primary care specialties.  Peyton: Here is an interesting fact: According to the Graham Center, Northeastern states receive high graduate medical education (GME) funding but produce relatively fewer primary care physicians. Northwestern states receive low GME funding but perform relatively better, producing slightly above the U.S. average (70.8 vs 69.8 primary care physicians per 100,000 people). However, even this remains far below Canada’s average of 119 primary care physicians per 100,000 people.  Right now, the United States is facing a growing physician shortage. According to the Association of American Medical Colleges, the country could face a shortage of up to 86,000 physicians by 2036, with primary care being one of the most affected areas. Arreaza: Another group that may help address the physician shortage is International Medical Graduates. We’ll cover this in more detail in a future episode, but it’s worth mentioning briefly here. We have highly trained physicians, including neurosurgeons, driving Uber. There is nothing wrong with that work, but their medical skills could be used to help more people. I’ll leave our listeners with that thought: IMGs can help. So, Peyton, are you interested in rural medicine? Peyton: I am very interested in Rural medicine, in fact my next few rotations will be back in South Dakota on the Pine Ridge Indian Reservation. Actually, the Pine Ridge Reservation is the poorest Indian Reservation in the country.  Peyton: The measure of any healthcare system is not how well it serves those closest to its centers of power, but how far its reach extends to those who need it most. If we are serious about health equity, the road forward must run through every small town, every county clinic, and every community that has been told to wait its turn. Their turn is now. References Association of American Medical Colleges (AAMC). The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. https://www.aamc.org/workforce American Academy of Family Physicians (AAFP). Rural Practice and Physician Recruitment.https://www.aafp.org Centers for Disease Control and Prevention (CDC). Rural Americans at Higher Risk of Death from Five Leading Causes.https://www.cdc.gov/media/releases/2017/p0112-rural-death-risk.html Cecil G. Sheps Center for Health Services Research. Rural Hospital Closures.https://www.shepscenter.unc.edu/programs-projects/rural-health/rural-hospital-closures/ Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001–2014. JAMA. 2016;315(16):1750–1766. https://jamanetwork.com/journals/jama/fullarticle/2513561 Health Resources & Services Administration (HRSA). Health Professional Shortage Areas (HPSAs).https://data.hrsa.gov/topics/health-workforce/shortage-areas Rural Health Information Hub. Healthcare Access in Rural Communities.https://www.ruralhealthinfo.org/topics/healthcare-access Rural Health Information Hub. Transportation to Support Rural Healthcare.https://www.ruralhealthinfo.org/topics/transportation Rural Health Information Hub. Rural Residency Planning and Development. https://www.ruralhealthinfo.org/topics/rural-residency-programs Centers for Disease Control and Prevention (CDC). Health and Access to Care in Rural America.https://www.cdc.gov/ruralhealth/index.html Measure of America. A Portrait of Los Angeles County 2026. Social Science Research Council.https://ssrc-static.s3.amazonaws.com/moa/APortraitofLosAngelesCounty2026.pdf Merritt Hawkins. Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/ Fenster, T. L., MD, Park, J., PhD, Huffstetler, A. N., MD, & Topmiller, M., PhD (2026). Graduate Medical Education Funding Does Not Flow to Primary Care Physician Production. American family physician, 113(4), 321–322. https://pubmed.ncbi.nlm.nih.gov/42101593/ Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. 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