Robert Whitfield MD discusses how the large geographic scale of the United States produces marked variation in healthcare infrastructure: tertiary care centers (with ICU and often multidisciplinary cancer centers) are concentrated in only a few large cities, while outside those areas care levels fall. He explains how this affects breast cancer treatment choices — notably that implant-based reconstruction is the dominant option in much of the U.S. because it can be performed at local hospitals with lower infrastructure requirements.
Chapters
We live in a huge country, not a little country. I live in Texas, of which you can play Spain inside. So, you know, it's a very complicated equation to get taken care of here in this country. Once you leave a, a city that's a million plus people, so at that level of, of infrastructure, you typically would have a tertiary care center. Yep. Now for everybody listening, that's a place that has a higher level of care. When I say tertiary, they'll have icu, they'll have different integrated forms of care. Maybe multidisciplinary cancer care. Not always, but typically they'll have a cancer center associated with it. But that's a very, very small number of cities in the United States. So rapidly, once you get outside of that, you have a much, much lower level of care. Not a bad level of care, but the lack of infrastructure, it becomes apparent very quickly for everybody listening. If you get diagnosed with breast cancer and we'll just say you don't go into the lumpectomy situation, you opt to have a mastectomy. The most dominant form of reconstruction, if you choose to do that in the United States, is going to be an implant based reconstruction, because that can be carried out at your local hospital and that is a function of the level of care provided in your area.
